1656 – Vertebral body tethering for adolescent idiopathic scoliosis

New MBS item.

Vertebral body tethering is a form of scoliosis surgery that aims to preserve spinal mobility. It is a thoracoscopic, minimally-invasive technique in which screws are placed into the vertebral bodies on the convex side of the coronal deformity. The screws are placed into the middle of the vertebral body with bicortical purchase under fluoroscopic guidance. A high-strength, braided polypropylene tether is then placed into the screw heads and sequentially secured to each screw after segmental compression. The technique achieves immediate post-operative partial correction of the spinal deformity. The pressure from the tether causes the vertebrae to grow denser and more slowly on the convex side of the curve, whilst the concave side of the spine continues to grow at a normal rate. As such, the spine gradually straightens as the patient grows.

Type: Therapeutic

Scoliosis is defined as a lateral S- or C-shaped curvature of the spine in the coronal plane of more than 10°, as measured by the ‘Cobb angle’ (the angle between the most titled upper and lower vertebrae). In the younger population, 85% of scoliosis cases are idiopathic (of unknown cause) after excluding congenital, syndromic, or neuromuscular causes. The incidence of scoliosis is similar in males and females; however, females have up to a 10-fold greater risk of curve progression. Adolescent idiopathic scoliosis refers to scoliosis in patients aged between 10 and 18 years. Adolescent idopathic scoliosis may cause back pain and is associated with visible deformity, which in turn is associated with emotional distress and diminished self-image. Surgery is typically recommended when the major thoracic Cobb angle exceeds 40°. If untreated, these curve progress into adulthood. Severe curvature may lead to respiratory impairment due to rib deformity.

• PASC meeting: 15 to 16 April 2021
• ESC meeting: 7 to 8 October 2021
• MSAC meeting: 25 to 26 November 2021