Scoliosis affects about 2-3 percent of the American population. This disease causes your spine to curve to one side and usually develops during childhood or early adolescence. For most patients, scoliosis treatment often relies on the help of a rigid brace. Although braces can prevent the progression of abnormal curvature, they can’t reverse the existing problem.
For children and teenagers with scoliosis who may need surgery, vertebral body tethering (VBT) may be a fusionless treatment option for carefully selected patients. VBT uses a flexible cord to guide continued spinal growth and may help improve spinal alignment while preserving motion. VBT candidacy depends on factors including the type and size of the curve, skeletal maturity, and how much growth remains.
What is Vertebral Body Tethering (VBT)?
Unlike spinal fusion, which uses stiff rods or bone grafts, vertebral body tethering uses a sturdy but flexible cord to pull on the outside of the abnormal curve, thus straightening the spine.
This procedure uses a child’s remaining growth to help guide spinal alignment. Vertebral body tethering has FDA clearance through the Humanitarian Device Exemption pathway, and a surgeon may recommend it only for appropriately selected patients. Your spine surgeon may recommend VBT based on the degree of your child’s spinal curve and their skeletal maturity. The components that make vertebral body tethering work include:
- Cord: Made of special polymer to realign the spine
- Bone Screws: They are inserted into the vertebrae to secure the cord
- Set Screws: These are positioned on top of the bone screws to maintain the cord’s tension
- Anchors: These are circular titanium alloy implants placed against the vertebrae to support the bone screws
How Does VBT Work?
Vertebral body tethering operates according to the principles of Hueter-Volkmann Law. It states that compressive forces that apply pressure to the spine slow down bone growth. VBT uses this idea to achieve growth modulation, allowing the spine to grow along a healthier path. Here are the steps that are taken during vertebral body tethering.
Step 1: Evaluation
During your child’s evaluation, a pediatric spine surgeon will ask for your child’s medical history and perform a physical examination. The surgeon will conduct imaging tests to identify the part of the spine affected, measure the degree of curvature, and how best to proceed with surgery.
The surgeon may also perform an X-ray of the spine to show bone placement and X-rays of the hand to help determine if your child has enough growth left for VBT. EOS imaging will also be done to show your child’s spine in a weight-bearing position, while an MRI will be performed to evaluate the nerves of the spine.
A spinal surgeon will also consider the curve’s flexibility, the child’s overall health, and family goals when determining whether VBT, bracing, spinal fusion, or continued monitoring is the most appropriate option.
Step 2: Surgery
On the day of your child’s surgery, you will arrive at the hospital, and your child will be admitted. During surgery, the surgeon will administer general anesthesia to your child and access their spine through small incisions in the side of the chest.
The surgeons will then use a fiber-optic video camera to help place titanium screws along the outside edge of your child’s abnormal spinal curve, and a strong, flexible cord is threaded through the screws.
They then tighten the cord to guide future spinal growth. As your child grows, the tether may help guide spinal alignment over time, gradually treating scoliosis.
The operation may take about 3 to 5 hours.
Step 3: Post-Surgery
After surgery, your child will be in pain, so they will receive IV pain medication until they’re able to take oral medication. They will also need help when getting out of bed and walking.
Pulmonary monitoring is crucial after surgery. The medical professionals will show them exercises to do so that their lungs can recover fast.
They may discharge your child two to three days after the procedure. But before that, the doctor will conduct X-rays to ensure the implants are stable. They’ll also check and redress their incisions.
Recovery varies by child and procedure. Many children return to school within a few weeks, while the timing for sports, bending, twisting, lifting, and other activities should be determined by the surgical team at follow-up visits.
Step 4: Follow-Up Care
Your child will follow up with their doctor three weeks after surgery to ensure the wound is healing properly. After about six weeks, your child may need to return for an evaluation by a pediatric spine surgeon. During this appointment, the surgeon may conduct X-rays and other imaging tests to assess the spinal alignment and position of the implants.
Your child may continue to visit the doctor every six months so that they can assess the changes in their scoliosis. In most cases, the VBT implants will remain in your child’s spine throughout their lifetime.
Why is VBT Good for Treating Scoliosis in Children?
Unlike bracing, which is generally intended to help slow or prevent further curve progression, VBT may help improve spinal alignment in selected patients. Here are some additional benefits of VBT:
Less Invasive Procedure
Because VBT is a minimally invasive surgery, your surgeon will enact slight trauma to your child’s delicate tissues. This may reduce tissue disruption and may be associated with less blood loss, less post-operative pain, and a quicker recovery than some open procedures, depending on the individual case.
Discreet Incisions
During the VBT procedure, the surgeon will access your child’s spine through an incision under their arm, making it easy to conceal the post-operative scars.
More Flexibility and Movement in the Spine
VBT is intended to preserve spinal motion compared with fusion-based procedures, although individual outcomes and activity guidance vary. Your child’s return to sports, dance, and other activities should follow their surgeon’s recovery guidance.
Little Downtime
Many children may return to school within a few weeks after surgery. Whether bracing, physical therapy, or other supportive care is needed depends on the child’s recovery plan. Although they can take part in physical activities, they aren’t allowed to bend and twist excessively for a while.
Who is Qualified for VBT?
Vertebral body tethering is not appropriate for every person with scoliosis. A pediatric spine specialist evaluates curve type and flexibility, curve severity, skeletal maturity, remaining growth, and overall health before recommending VBT. Potential candidate characteristics may include:
- Be diagnosed with idiopathic scoliosis
- Be at least 10 years old
- Have a spinal curve of approximately 35–70 degrees
- Have a skeletal maturity of 0-2 on the Risser scale
Get Comprehensive Scoliosis Treatment for Your Child
If your child has scoliosis and you would like to explore whether vertebral body tethering or another treatment option may be appropriate, The Advanced Spine Center can provide a comprehensive pediatric spine evaluation. Contact The Advanced Spine Center to schedule an appointment in New Jersey.
Updated September 2026.