Vertebral Body Tethering

Vertebral Body Tethering (VBT) is a fusionless spine surgery that treats idiopathic scoliosis by using a strong flexible cord to straighten out the spine while preserving your child's motion.

Our team performs VBT as a safe, minimally invasive procedure that helps to correct scoliosis at the time of surgery and continues as your child grows.

What is Vertebral Body Tethering?

VBT is a surgical procedure approved by the FDA in 2019 to help correct a common type of scoliosis, known as idiopathic scoliosis. VBT works by attaching screws to the outside of the scoliosis curve and connecting a flexible cord, called a tether, to each screw on affected vertebrae. The cord is then tensioned to guide scoliosis correction with no further lengthening required. As your child grows, VBT allows for additional correction of spinal curvature while maintaining spine flexibility. For most patients, VBT is a one-time surgery that requires little to no correction, offering the comfort and convenience of a less invasive surgery with a quicker recovery time. VBT allows kids to retain their flexibility and range of motion as they grow and continue living an active life, because it does not fuse vertebrae.

Is VBT right for my child?

VBT is most appropriate for children who are still growing and who also have spinal flexibility. There are other criteria that should be considered when thinking about VBT for your child, including:

• A spine curvature, or Cobb angle, between 35-65 degrees.
• An idiopathic scoliosis diagnosis.
• Scoliosis that continues to progress or worsen despite bracing.
• Roughly between the ages of 8 to 16.

Other progressive scoliosis risk factors may also make your child an ideal VBT candidate, and these will be discussed at your first visit. If you or your child are interested in VBT, please call our office for additional information or request an appointment below.

Choosing MU Health Care for VBT surgery

Our team of pediatric orthopaedic specialists, led by Daniel Hoernschemeyer, MD, helps advance fusionless surgical treatments for idiopathic scoliosis. Our experts have published research, performed training on scoliosis treatments, and led panels with the goal of improving patient outcomes, while also training the next generation of doctors.

As Missouri’s leader in VBT, our team has years of experience successfully treating patients with complex scoliosis. Dr. Hoernschemeyer is nationally recognized for his care and expertise in pediatric orthopaedics.

Your first visit

During your first visit, our team will evaluate your child's medical history and perform a physical exam of your child's back. We will also want X-rays of your child's spine standing and laying down to evaluate spine flexibility as well as a hand X-ray to determine skeletal maturity and future bone growth. Our team has access to the latest and most advanced technology that help us measure your child's spine curvature and determine if they are a candidate for VBT surgery.

If you have recent images of your child's spine, our team of experts can also discuss VBT eligibility with you during a telehealth visit. Please call our office for more information.

If VBT is appropriate for your child, our pediatric orthopedic team will provide a personalized treatment recommendation and plan.

Before surgery

Before your child's VBT surgery, you will have a scheduled preoperative appointment to discuss surgical details as well as the recovery process. Your child will undergo advanced imaging, like a CT scan and MRI of the spine, as well as an evaluation of lung function and preoperative blood work. Our surgery team also will discuss the risks, benefits and alternatives with you and your child.

Patients and families are invited to tour our Children's Hospital with a child-life specialist two to three weeks before the surgery date. Often, a tour can help decrease stress and anxiety and prepare your family for a more successful recovery. Our team also can help you plan accommodations during your child's recovery.

VBT surgery:

• Uses anesthesia and pain medications, which our team will discuss in detail during the preoperative visit.
• Takes four to six hours in most cases, depending on how many vertebrae are being treated.
• Requires two to three days in the hospital for recovery.

What to expect after surgery

After VBT surgery, your child will go to the pediatric floor and start recovery following the Team Integrated Enhanced Recovery (TIGER) protocol. This unique team surgery protocol is designed to reduce the length of your child's hospital stay, improve recovery time and get your child back to their favorite activities. We set daily goals and expectations for pain control and mobility to help eliminate postoperative complications. Medication to help with pain will be given as needed and decreased over the course of two weeks at home.

Our team will take additional X-rays of your child standing before you go home to accurately measure the spinal curvature immediately after surgery. X-rays will be taken at every follow-up visit starting six weeks after recovery to follow further improvement of scoliosis with continued growth. Your child should be discharged two to three days after surgery.

When you return home, your child will be able to walk, climb stairs and do most normal activities. Your child's restrictions will include no bending, lifting over 15 pounds or twisting. We will ask to see your child back in our specialty clinic six weeks after surgery to check incisions and repeat X-rays of the spine. In most cases, your child can return to normal activity without restrictions three months from the date of surgery.

Patient testimonials

Evelyn “Dee” Gilbert
Columbia, Missouri

We first met Dr. Dan Hoernschemeyer in spring 2014. He was treating my son Ryan for a mild case of scoliosis. Later that year, my daughter, Avory, began exhibiting signs of scoliosis when she was 11 with a 30-degree curvature. By July of 2015, the curve had advanced. Dr. Dan felt confident that she would be a good candidate for vertebral body tethering.

I cannot say enough good things about Dr. Dan and his staff. They took the time necessary to fully explain and go over everything that would happen before and after Avory’s surgery. They even put me in touch with the mother of another VBT patient, and she was able to share her experiences with the procedure. By the day of the surgery, I was very at ease knowing we were making the best choice for Avory.

Avory is now able to compete in her high-level sports with no reduction in mobility. She currently competes in USA Gymnastics Level 9 competition. I cannot thank Dr. Dan enough.

Shelli Panzer
Topeka, Kansas

Our daughter, Grier, was 6 years old when she was diagnosed with idiopathic scoliosis. We spent the next six years “managing” her curves through various means, but it became apparent that we were losing the battle. We met Dr. Dan Hoernschemeyer in 2018, and after his thorough evaluation, felt that Grier would be an ideal candidate for double VBT.

Dr. H, Nicole Buckler and the entire team of surgical nurses, nurses, occupational therapists, physical therapists, Child Life specialists, etc., were absolutely top notch in every way. The professionalism and kindness shown to Grier and us during her recovery is hard to describe.

Before surgery, Grier was extremely active in volleyball and basketball, and post-recovery nothing has changed! This past school year, she completed her first year of middle school sports and was able to compete in every way without any restrictions.

We are beyond grateful to Dr. H and his team for giving our girl her life and the ability to do everything that she loves without a second thought!