Anterior Vertebral Tethering: A Less Invasive Option for Scoliosis Treatment

In this video, John T. Braun, MD, orthopedic spine surgeon, and Brian Grottkau, MD, orthopedic spine and scoliosis surgeons in the Pediatric Orthopaedics Service at Mass General for Children, present the Anterior Vertebral Tethering (AVT) System, a minimally invasive, fusionless treatment option for adolescent idiopathic scoliosis. Dr. Braun, who developed the system, and Dr. Grottkau, chief of Pediatric Orthopaedics, work alongside David Lawlor, MD, to take an innovative team approach to scoliosis treatment and surgery that is unparalleled in the region.

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Transcript

Anterior vertebral tethering is a minimally invasive surgery for scoliosis that preserves the growth, motion and function of the spine. In contrast to fusion surgery, which is maximally invasive and profoundly non-physiologic, the most common type of scoliosis is adolescent idiopathic scoliosis which affects 2%-4% of all populations and represents about 90% of all scoliosis. Tethering was developed by me and others to treat scoliosis during these growing years. Anterior vertebral tethering for scoliosis surgery is a new and exciting technology. It is generally used for adolescents who have progressive curvatures of the spine who have failed brace treatment. Prior to this technology, our only option was to fuse their spines and make them rigid by using screws and rods. This allows the preservation of flexibility while still controlling the curvature's progression. In fact, in someone who is still actively growing, you can get correction of the curvature by guiding growth with stapling or plating knock-knees or bow-legs across the growth plate. In scoliosis, we are very interested in treating the curve, but without sacrificing other things that are important to the spine. So this is a natural evolution into a more physiologic and more patient-friendly treatment.

It is minimally invasive, that is flexible, and that preserves all those things that are really important to your spine staying a spine and not becoming a long rigid segment, or even a femur in your back. The anterior vertebral tethering procedure preserves motion, so it will ultimately result in more normal spinal motion, which should allow these kids two things. First, it will allow them to have a more functional spine much like the native spine is, and the second thing is over time, our hope is that the preservation of motion diminishes the likelihood of adjacent segment degeneration where you have wearing out of discs on either side of the fusion construct with problems down the road 30, 40 or 50 years. The one thing we pride ourselves on, we think it makes us different here without the anterior vertebral tethering program, is that we work as a team. We do all of these operations together with Dr. Braun who really was the mind behind the tethering procedure, and Dr. Lawler who is one of my pediatric surgery colleagues. He is our access surgeon on all of the operations we do, and we think this makes us distinct from other places that perform this in the world, is every patient is treated by all three of us as a team.

We spent 20 years developing this novel treatment for scoliosis following a translational arc from bench to bedside, from basic research, to clinical treatment. Currently, we are in a clinical research phase and Massachusetts General Hospital is poised, really, to help us get to the next level.

Learn more about Children's Orthopaedics at Mass General

Refer a patient to the Department of Orthopaedic Surgery