Prospective cohort of 21 skeletally immature AIS patients treated with thoracoscopic anterior vertebral body tethering after brace failure. The study asks whether this fusionless, growth-modulating technique achieves durable curve correction while preserving sagittal alignment and spinal motion.
The surgical alternative to VBT in this population is posterior spinal fusion — an operation that stops spinal growth, eliminates motion at fused segments, and risks accelerated lumbar disc degeneration at L5-S1. For a 10-year-old with a 48° curve and Risser 0, that is a significant trade-off.
This paper establishes that VBT can achieve major curve correction (48° to 10°) with continued gradual improvement over 2+ years, without disturbing sagittal alignment or requiring fusion. When you see a skeletally immature AIS patient (Risser ≤2, Sanders ≤4) whose thoracic curve has progressed past 40° despite bracing, VBT is a real option. If the curve retains ≥30% flexibility and kyphosis is between 20° and 40°.
Counsel families carefully: the implants are off-label, tether breakage is a real risk (detectable as >5° angulation between adjacent screws), and revision or conversion to fusion may be required. Functional and motion-preservation outcomes have not been formally measured in this cohort, so the motion-sparing advantage over fusion remains theoretical at this stage.
Prospective cohort of 21 skeletally immature AIS patients treated with thoracoscopic anterior vertebral body tethering after brace failure. The study asks whether this fusionless, growth-modulating technique achieves durable curve correction while preserving sagittal alignment and spinal motion.
The surgical alternative to VBT in this population is posterior spinal fusion — an operation that stops spinal growth, eliminates motion at fused segments, and risks accelerated lumbar disc degeneration at L5-S1. For a 10-year-old with a 48° curve and Risser 0, that is a significant trade-off.
This paper establishes that VBT can achieve major curve correction (48° to 10°) with continued gradual improvement over 2+ years, without disturbing sagittal alignment or requiring fusion. When you see a skeletally immature AIS patient (Risser ≤2, Sanders ≤4) whose thoracic curve has progressed past 40° despite bracing, VBT is a real option. If the curve retains ≥30% flexibility and kyphosis is between 20° and 40°.
Counsel families carefully: the implants are off-label, tether breakage is a real risk (detectable as >5° angulation between adjacent screws), and revision or conversion to fusion may be required. Functional and motion-preservation outcomes have not been formally measured in this cohort, so the motion-sparing advantage over fusion remains theoretical at this stage.