Growth Modulation for Childhood Scoliosis: From Where Have We Come, and Where are We Going?

Abstract

Growth modulation by anterior vertebral body tethering (AVBT) has the potential to transform scoliosis treatment in children and adolescents by reducing spinal curvature without definitive fusion. To date, nearly all patients with AVBT have been treated in off-label use, sometimes with controversial indications. Early published experience (5 papers) in 67 patients and unpublished data (8 presentations) in over 200 patients suggests that AVBT can effectively prevent curve progression in the majority of skeletally immature patients. Rates of complications and secondary surgery for curve progression or overcorrection are variable and necessitate further investigation. With the recent FDA regulatory approval of the vertebral tether under a Humanitarian Device Exemption (HDE) mechanism, we are poised to better understand the long-term outcomes of this novel and potentially disruptive approach to the treatment of pediatric spine deformity.