Vertebral Body Tethering (VBT): A Motion-Preserving Alternative for Scoliosis Treatment

Scoliosis treatment has evolved rapidly over the past several decades. One of the most promising developments is Vertebral Body Tethering, or VBR for short, a minimally invasive procedure designed particularly for growing adolescents with scoliosis. 

This innovative technique has gained attention for its ability to balance structural correction with functional outcomes. However, because VBT relies on growth modulation, careful patient selection and long-term monitoring are essential for success. At Rememore, VBT is approached as a highly specialized procedure, combining surgical precision with detailed growth assessment to ensure optimal results.

While the VBT procedure provides important advantages, such as motion preservation and growth modulation, it also carries specific risks like tether breakage or possible need for revision surgery. 

Understanding candidacy criteria, surgical steps, recovery expectations, potential complications, and long-term considerations is essential for families evaluating treatment options.

What Is Vertebral Body Tethering (VBT)?

Vertebral Body Tethering is a growth-modulation technique that uses a flexible cord (tether) attached to screws placed along the curved side of the spine instead of fusing the vertebrae together. 

Designed to treat adolescent idiopathic scoliosis, VBT is approved in the United States under Humanitarian Device Exemption (HDE) and is typically performed in specialized pediatric spine centers.

The core principle behind VBT is that controlled compression on one side of the spine slows growth there, allowing the opposite side to catch up and straighten the curve naturally.

How VBT Differs from Traditional Spinal Fusion

While both VBT and traditional spinal fusion aim to correct scoliosis, they function differently.

Preserving spinal mobility is one of the most significant advantages of VBT surgery.

Who Is a Candidate for VBT Surgery?

Patient selection is a critical factor in achieving optimal outcomes with VTB. The procedure is most often recommended for adolescents who are still growing and have moderate to severe scoliosis curves.

Patients who may qualify for VBT typically meet conditions like:

• Diagnosed with adolescent idiopathic scoliosis

• Curve magnitude generally between 40° and 65°

• Significant remaining spinal growth

• Flexible spinal curvature

• No prior spinal fusion surgery

Bone maturity is often measured using the Risser sign and Sanders staging system to ensure growth potential remains.

However, certain cases may not be appropriate for this procedure:

• Fully grown adolescents or adults

• Extremely rigid curves

• Neuromuscular scoliosis

• Severe structural spinal abnormalities

Because Vertebral Body Tethering requires highly precise patient selection and growth assessment, it is essential to be evaluated by an experienced spine team. At Rememore, patient candidacy is determined through advanced imaging, growth analysis systems such as Risser and Sanders staging, and a multidisciplinary approach led by specialized surgeons.

How Is Vertebral Body Tethering Performed?

Vertebral body tethering surgery is usually performed using a minimally invasive thoracoscopic approach. With this technique, surgeons are able to access the spine through small incisions on the side of the chest.

The VBT procedure usually takes several hours and is performed under general anesthesia.

The steps of VBT surgery look  like:

1. Small incisions are made along the side of the torso.

2. Screws are placed into the vertebral bodies along the convex side of the curve.

3. A strong, flexible tether is threaded through the screws.

4. The tether is tensioned to partially correct the curve.

5. The incisions are closed.

Unlike spinal fusion, the correction is not fully achieved during VBT surgery. Instead, the remaining growth gradually improves alignment over time.

Benefits of Vertebral Body Tethering

The increasing popularity of vertebral body tethering is thanks to its ability to correct scoliosis while maintaining natural spinal movement. This is particularly important for physically active adolescents.

The key advantages of VBT are:

• Preserves spinal flexibility

• Allows continued growth correction

• Minimally invasive approach

• Faster return to daily activities compared to fusion

• Avoids permanent fusion of vertebrae

Many young athletes tend to prefer VBT surgery because it maintains a greater range of motion.

Long-Term Functional Considerations

Because VBT does not permanently fuse vertebrae, patients typically retain:

• Better rotational movement

• Improved bending capacity

• More natural spinal biomechanics

However, long-term data is still evolving, and patients require ongoing monitoring.

Risks and Potential Complications of VBT Surgery

As with any surgical procedure, vertebral body tethering carries certain potential risks. Having a comprehensive understanding of these risks helps families make informed decisions.

Possible complications of VBT surgery include:

• Tether breakage

• Overcorrection of the curve

• Under-correction

• Pulmonary complications

• Need for revision surgery

Tether breakage is one of the most discussed risks when it comes to VBT surgery. While some breakages do not require intervention, others may necessitate additional procedures.

Recovery Timeline After VBT Surgery

The recovery timeline following vertebral body tethering surgery is generally progressive and dependent on the growth. 

Because the VBT procedure preserves spinal motion and does not involve any bone fusion, the healing process focuses on soft tissue recovery, gradual activity return, and long-term monitoring of spinal correction.

Each phase has specific physical expectations and activity guidelines.

• First 6 Weeks:  This is the early healing phase. Mild to moderate discomfort is normal but improves steadily. Walking is encouraged, while heavy lifting, twisting, and sports are restricted. Most patients return to school within a few weeks.

• 3 to 6 Months: Mobility and energy levels improve significantly. Light sports and strengthening exercises may gradually resume with medical approval. Follow-up visits continue to monitor spinal correction.

• One Year and Beyond: Most patients return to full activities, including sports. Spinal flexibility is preserved, and growth-driven correction may continue until skeletal maturity, with periodic monitoring recommended.

Why Choose Rememore Clinic for Vertebral Body Tethering?

Vertebral Body Tethering is a highly specialized procedure that requires not only surgical precision but also deep expertise in spinal growth dynamics. Choosing the right clinic directly impacts both safety and long-term outcomes.

At Rememore:

• VBT procedures are performed by experienced surgeons specialized in adolescent scoliosis
• Advanced pre-operative planning ensures accurate growth modulation strategies
• Minimally invasive thoracoscopic techniques are used to reduce recovery time
• Patients benefit from structured long-term follow-up protocols
• International patients receive comprehensive care coordination

Frequently Asked Questions (FAQ)

Is vertebral body tethering FDA-approved?

Yes, VBT is approved in the United States under a Humanitarian Device Exemption for specific scoliosis cases.

Can the tether be removed later?

In some cases, the tether can be adjusted or removed if complications occur, but this depends on individual circumstances.

Does VBT completely straighten the spine?

The spine is partially corrected during surgery, with additional correction occurring gradually as the patient grows.

Is VBT painful?

Postoperative discomfort is expected, but pain is managed with medication and typically improves within weeks.

Will insurance cover VBT surgery?

Coverage varies by provider and country. Pre-authorization is often required.

Where can I get VBT surgery?

Vertebral Body Tethering is available at specialized spine centers. Clinics such as Rememore offer comprehensive evaluation, surgical expertise, and long-term follow-up tailored specifically for adolescent scoliosis patients.