Anterior Vertebral Body Tethering (AVBT)

Anterior Vertebral Body Tethering (AVBT) is a surgical option for treating scoliosis that uses a strong, flexible cord, or tether, to straighten the spine without fusing the bones. Unlike traditional spinal fusion, AVBT allows the spine to continue growing and moving.

What Does AVBT Surgery Involve?

AVBT is performed using small ports in the front/side of the chest and a thoracoscope, a flexible tube with a light and video camera at the tip. The surgeon attaches the tether to the front (anterior) part of the spine using screws placed in the vertebrae. As your child grows, the tension from the tether helps straighten the spine.

Who Is an AVBT Candidate?

Your child may be a candidate for AVBT if they have moderate to severe scoliosis (typically between 40 and 60 degrees). Because AVBT uses growth to help correct the curve, this strategy works best in children who are still growing (usually ages 8–16). This can be determined using tests such as the Sanders score, which assesses bone maturity using X-rays. A Sanders score of 5 or more means that AVBT may be a viable treatment option.

What Are the Benefits of This Approach?

AVBT preserves spinal motion and flexibility, so it may be a good choice for parents hoping to avoid or delay spinal fusion surgery for their child. This approach can lead to more natural spine movement after recovery than traditional fusion.

What Type of Anesthesia Is Used?

AVBT surgery is performed under general anesthesia, meaning your child will be fully asleep and feel no pain during the procedure.

What Are the Risks?

As with any surgery, AVBT surgery carries some risks, including:

• Infection
• Lung complications (due to surgery near the chest)
• Need for additional surgery, including spinal fusion
• Overcorrection/Undercorrection
• Tether breakage or loosening over time
• Injury to nerves or blood vessels (rare)

What Does Recovery Involve?

After surgery, your child will stay in the hospital for 2–4 days. Their pain is carefully monitored and managed with medication. Most children are up and walking shortly after surgery and going up and down stairs prior to leaving the hospital.

Recovery time can vary based on several factors, but typically:

• Children can return to school within 2–3 weeks.
• Light physical activity can resume after 4–6 weeks.
• Additional physical activities can resume after 3 months.
• Full recovery typically takes a few months.

Following the guidance of your child’s care team will help ensure the best results.

What Improvements Can My Child Expect?

With proper follow-up and adherence to the recovery plan, most children experience:

• A straighter spine over time
• Improved posture and balance
• Higher physical comfort and confidence
• Preserved spinal flexibility

Because ABVT uses your child’s growth to straighten the spine, it may take months for results to become fully visible.

What Are the Alternative Treatment Options?

There are other ways to treat scoliosis, including both nonsurgical and surgical options. Each option comes with different goals and risks. The right choice depends on your child’s age, curve size, and growth stage.

Nonsurgical Options

Nonsurgical options are usually explored before considering surgery.

• Bracing: A customized back brace can help slow or stop curve progression, especially if your child is still growing.
• Physical therapy: Physiotherapeutic scoliosis-specific exercises (PSSE) to strengthen core and back muscles to manage mild curvature or to supplement other treatments. PSSE can include the Schroth method.
• Observation: For mild curvature, your child may only need regular checkups and X-rays to monitor changes over time.

Surgical Options

If AVBT isn’t the right choice for your child, your surgeon may recommend:

• Spinal fusion surgery: This treatment for severe scoliosis straightens the spine by permanently joining (fusing) the affected vertebrae together using metal rods.
• Growing rods or expandable implants: These implants are adjusted over time to treat younger children with early-onset scoliosis who are still growing rapidly.

Your child’s surgeon will explain the different options and help determine what strategy would best help your child.

What Is the Outlook for AVBT Surgery?

The long-term outcomes for AVBT are promising, especially in kids who are still growing. Many children go on to live active, healthy lives with good spinal alignment and preserved mobility.