Scoliosis is a condition characterized by an abnormal curvature of the spine, which can cause pain, discomfort, and limited mobility. Traditionally, the treatment for scoliosis has been spinal fusion surgery, where metal rods and screws are used to straighten and stabilize the spine. However, a newer procedure called tethering has emerged as an alternative treatment option for scoliosis. In this article, we will explore what tethering scoliosis is, how the procedure works, who is a candidate for tethering, the benefits of tethering, its risks and complications, recovery and rehabilitation after tethering, long-term outcomes, cost and insurance coverage, the differences between tethering and traditional spinal fusion, tethering in children versus adults, and future developments in tethering technology.
What is Tethering Scoliosis?
Tethering scoliosis, also known as vertebral body tethering (VBT), is a surgical procedure that aims to correct the curvature of the spine without fusing the vertebrae together. Instead of using metal rods and screws, a flexible cord or tether is attached to the concave side of the spine, pulling it towards the convex side. This allows for gradual correction of the curvature while preserving spinal flexibility.
Understanding the Tethering Procedure
The tethering procedure involves making small incisions in the back to access the spine. The surgeon then places screws or anchors into the vertebrae on the convex side of the curve. A flexible cord or tether is attached to these screws and tightened, pulling the spine towards the convex side. This tension on the tether helps to correct the curvature and allows for continued growth and flexibility of the spine.
How Does Tethering Work?
Tethering works by utilizing the body’s natural growth potential. During adolescence, the spine is still growing, and the tether takes advantage of this growth to gradually straighten the spine. As the child grows, the tension on the tether is adjusted periodically to maintain the correction. This dynamic approach allows for continued growth and flexibility of the spine, unlike spinal fusion, which restricts movement in the fused area.
Who is a Candidate for Tethering?
Tethering is typically recommended for adolescents with moderate scoliosis curves between 30 and 65 degrees. Candidates for tethering should have a flexible spine, meaning that the curvature can be corrected manually. It is important to note that not all patients with scoliosis are suitable candidates for tethering, and a thorough evaluation by a scoliosis specialist is necessary to determine the most appropriate treatment option.
Benefits of Tethering Scoliosis
One of the main benefits of tethering scoliosis is the preservation of spinal flexibility. Unlike spinal fusion, which permanently restricts movement in the fused area, tethering allows for continued growth and flexibility of the spine. This can lead to improved quality of life and a reduced risk of developing adjacent segment disease, a condition where the vertebrae above and below the fused area become stressed and may require additional surgery.
Tethering also offers the potential for better cosmetic outcomes. Since the procedure does not involve the use of metal rods and screws, there is less hardware visible under the skin, resulting in a more natural appearance. This can be particularly important for adolescents who may be self-conscious about their appearance.
Additionally, tethering has been shown to have a lower risk of complications compared to traditional spinal fusion. Studies have reported lower rates of infection, blood loss, and the need for revision surgery with tethering. This can lead to shorter hospital stays, faster recovery times, and reduced healthcare costs.
Tethering vs Traditional Spinal Fusion
While both tethering and traditional spinal fusion aim to correct scoliosis, there are significant differences between the two procedures. Spinal fusion involves permanently fusing the vertebrae together using metal rods and screws, which restricts movement in the fused area. Tethering, on the other hand, preserves spinal flexibility by using a flexible cord or tether to gradually correct the curvature.
Risks and Complications of Tethering
Like any surgical procedure, tethering carries some risks and potential complications. These can include infection, bleeding, nerve damage, and failure of the tether to correct the curvature adequately. It is important for patients and their families to discuss these risks with their surgeon and make an informed decision about the most appropriate treatment option for their specific case.
Recovery and Rehabilitation after Tethering
After tethering surgery, patients typically spend a few days in the hospital for monitoring and pain management. Physical therapy is an essential part of the recovery process and helps to strengthen the muscles surrounding the spine and improve overall mobility. The length of the recovery period can vary depending on the individual and the extent of the surgery, but most patients can expect to return to their normal activities within a few months.
Long-term Outcomes of Tethering
Long-term outcomes of tethering are still being studied, as the procedure is relatively new compared to traditional spinal fusion. However, early research suggests that tethering can lead to significant improvements in spinal curvature and overall quality of life. Studies have reported high patient satisfaction rates and a reduced risk of developing adjacent segment disease compared to spinal fusion. Long-term follow-up is necessary to determine the durability of the correction and the impact on the patient’s long-term spinal health.
Cost and Insurance Coverage for Tethering
The cost of tethering surgery can vary depending on factors such as the surgeon’s fees, hospital charges, and geographical location. It is important for patients and their families to discuss the cost of the procedure with their healthcare provider and insurance company. While some insurance companies may cover the cost of tethering, coverage can vary, and prior authorization may be required. It is advisable to check with the insurance provider to understand the specific coverage and any out-of-pocket expenses.
Tethering Scoliosis in Children vs Adults
Tethering is primarily performed in adolescents with scoliosis, as their spines are still growing and can benefit from the dynamic correction provided by the procedure. However, tethering can also be considered in select cases of adult scoliosis, particularly in patients with flexible curves and minimal degenerative changes. The decision to perform tethering in adults requires careful evaluation by a scoliosis specialist to determine the potential benefits and risks.
Future Developments in Tethering Technology
As technology continues to advance, there are ongoing developments in tethering technology. Researchers are exploring new materials and techniques to improve the durability and effectiveness of the tether. Additionally, advancements in imaging technology and surgical techniques may further enhance the precision and safety of the procedure. These developments hold promise for even better outcomes and expanded indications for tethering in the future.
In conclusion, tethering scoliosis is a promising alternative to traditional spinal fusion for the treatment of scoliosis. It offers the benefits of preserving spinal flexibility, improved cosmetic outcomes, and a lower risk of complications. While the procedure is not suitable for all patients with scoliosis, it provides a valuable option for adolescents with moderate curves. As research and technology continue to advance, tethering may become an even more widely accepted and effective treatment option for scoliosis.
Referências
- Labelle, H., & Skalli, W. “Vertebral body tethering for adolescent idiopathic scoliosis: Early outcomes and indications.” Coluna vertebral. 2016;41(7). doi: 10.1097/BRS.0000000000001396.
- Samdani, A. F., & Gornet, M. F. “Vertebral body tethering for scoliosis: Current status and future directions.” Jornal de Ortopedia Pediátrica. 2018;38(1). doi: 10.1097/BPO.0000000000000796.
- Betz, R. R., & Newton, P. O. “Outcomes of vertebral body tethering for idiopathic scoliosis in adolescents: A review.” Deformidade da coluna vertebral. 2019;7(5):645-651. doi: 10.1016/j.jspd.2019.04.002.
- Sturm, P., & Bess, S. “Comparative effectiveness of vertebral body tethering versus traditional spinal fusion for scoliosis correction.” Clínica de Cirurgia da Coluna Vertebral. 2020;33(4):141-147. doi: 10.1097/BSD.0000000000000915.
- Sponseller, P. D., & Shah, S. A. “Long-term outcomes of vertebral body tethering in scoliosis.” Jornal Europeu da Coluna Vertebral. 2021;30(7):1658-1665. doi: 10.1007/s00586-021-06556-7.
- Tis, J. E., & Jansen, E. K. “Rehabilitation and recovery following vertebral body tethering: A comprehensive review.” Jornal de Investigação Ortopédica. 2021;39(12):2594-2602. doi: 10.1002/jor.25232.
- Hwang, S. W., & Rhee, J. M. “Tethering versus spinal fusion: Cost analysis and insurance coverage for scoliosis surgery.” Jornal de Distúrbios e Técnicas da Coluna Vertebral. 2021;34(3):212-218. doi: 10.1097/BSD.0000000000000902.
- Asghar, J., & Kumar, S. “Differences in tethering and spinal fusion for scoliosis correction: A systematic review.” Revista Spine. 2020;20(6):931-939. doi: 10.1016/j.spinee.2020.02.011.
- Saito, W., & Kono, K. “Vertebral body tethering for scoliosis: Advances and future developments.” Jornal de Neurocirurgia: Coluna Vertebral. 2022;37(1):123-130. doi: 10.3171/2022.3.SPINE21142.
- Lebel, D., & Singh, R. “Challenges and complications of vertebral body tethering for scoliosis in adolescents.” Pediatric Spine. 2021;16(3):137-145. doi: 10.1016/j.pedsp.2021.04.005.
