Vertebral Body Tethering (VBT)

For many years, spinal fusion was the only surgery for the treatment of idiopathic scoliosis in adolescents. Today, however, there is a new and innovative minimally invasive method: dynamic scoliosis spinal rearrangement, a less invasive technique, accompanied by significant advantages for the young patient.

Dynamic scoliosis rearrangement or, as it is mentioned in the Anglo-Saxon literature, Vertebral Body Tethering (VBT) is a less invasive and mainly, less restrictive surgical method for the treatment of adolescent idiopathic scoliosis.

It is not a spinal fusion and does not affect the flexibility of the spine in the slightest. Instead, it utilizes the child’s natural development to achieve progressive correction of curvature over time. The process is done through very small incisions. The spine surgeon places special screws on the side of the vertebrae – the so-called, anchor points. It then attaches a flexible but strong cord, which is anchored to each screw separately and helps correct the curvature.

It is a developmentally guided treatment, which follows the child’s natural development to correct scoliosis gradually, in a natural way. The operation is minimally invasive, the rehabilitation is shorter and the flexible material remains permanently in place, without however affecting the child’s daily activity.

This surgical technique received approval from the FDA (U.S. Food and Drug Administration) in August 2019.

The technique is based on the philosophy that spinal development can be used to benefit the patient. As the child grows, dynamic vertebral rearrangement does not hinder this development but guides it, offering correction in the areas that present scoliosis, mainly in the thoracic and thoracic lumbar part of the spine.

The basic principle of VBT is to slow down growth on the curved side of the spine, giving time and space for the hollow side to grow more. This process leads to a gradual alignment of the spine.

During the operation, very small incisions are made with a thoracoscopic or minimally invasive technique. Through these incisions, metal titanium screws are placed in the anterior part along the vertebrae, on the side that shows a curvature. Access is safe, away from the spinal cord and nerves.

After the screws have been correctly placed and their position has been confirmed visually and radiologically, a flexible but durable cord is applied along the screws. This cord is gradually stretched and fixed at each level, contributing to the partial correction of scoliosis.

After the completion of the procedure, an X-ray examination is performed and a drainage pipe is placed in the chest to remove fluids and air, and then the incisions are closed.

Gradually, as the child grows and the spine continues to develop, the pressure exerted on the curved side slows down its development allowing the concave side to develop, resulting in the gradual correction of the deformity.

Overall, part of the correction is achieved directly through the surgical technique, while the rest of the improvement comes naturally with the development of the body, offering a functional and aligned result with the passage of time.

Recovery is significantly faster with this surgical method.

• The patient is discharged after about 5 days
• Chest drainage tubes are usually removed within the first 2-3 days
• Daily activities are allowed after 6 weeks
• No use of a brace is required postoperatively
• Checking the correction continues with X-rays for the next few years until the completion of skeletal development
• The child can return to school in 3 weeks

Dynamic Spondylanalysis is used in cases where scoliosis continues to worsen even with the use of a brace. It is an alternative to classic posterior spinal fusion, but it is only applied to selected patients.

The dynamic spinal reassignment technique is mainly indicated for children and adolescents aged 10 to 16 years, who have not yet completed their development (skeletal maturity) and have been diagnosed with severe idiopathic scoliosis.

Specifically, it concerns cases where the angle of curvature of the spine varies between 40° and 70°, while it can be applied even to larger curvatures, as long as there is sufficient flexibility of the spine.

This surgical technique should be performed exclusively by a specialized spine surgeon, with extensive experience and specialization in operations of this type and, especially, in the anterior access of the spine.

When VBT is successfully implemented, it can provide significant benefits to the adolescent, including:

• Maintaining the natural mobility and flexibility of the spine
• Leads to progressive correction of scoliosis
• Faster postoperative recovery, since small incisions do not injure the muscles
• The use of a brace is no longer required after surgery
• The implantable materials remain permanently in the spine, unless a problem arises in the future (cord breakage).

The success of Vertebral Body Tethering (VBT) depends crucially on the expertise and experience of the spine surgeon. It is an advanced, technically demanding surgical technique, which requires a deep knowledge of the anatomy of the spine, high scientific training in anterior accesses and great precision in the handling of materials.

Dr. Konstantinos Starantzis, a specialized spine surgeon with many years of experience in Greece and abroad, is one of the few surgeons who apply dynamic spinal realignment in Greece. He is the Director of the Spine Department of the Osteon Orthopedic Clinic, which has been certified as  a Center of Excellence in Spine Surgery by the EUROSPINE, the largest European spine surgery organization.

Having been trained in specialized international centers, Dr. Starantzis has the required experience of many years in scoliosis surgery in children and adolescents, approaching each case with personalized care and absolute surgical precision.