Spinal Fusion or Vertebral Body Tethering (VBT) for Scoliosis?
Scoliosis—characterized by a sideways curvature of the spine—can, in certain cases, require surgical intervention. Today, two primary surgical options are most commonly discussed: Vertebral Body Tethering (VBT) and spinal fusion. In this article, we’ll examine both techniques by exploring their definitions, pros and cons, patient suitability, and how they affect daily life.
1. What Are VBT and Spinal Fusion?
VBT is a technique that aims to correct the spinal curvature while preserving spinal flexibility. It involves placing screws along the vertebral bodies and connecting them with a flexible cord (tether). Positioned along the outer edge of the curve, this tether slows growth on that side, allowing the inner curve to catch up over time and gradually balance out.
Spinal fusion, on the other hand, is the more traditional method. It involves correcting the curvature and then stabilizing the affected vertebrae with metal rods and bone grafts. Over time, the vertebrae fuse together into one solid segment, permanently eliminating movement in that portion of the spine to prevent further curvature.
2. Pros and Cons
Choosing a surgical method means weighing not only what’s technically possible, but also how each option affects movement, aesthetics, recovery, and long-term lifestyle. Although both methods are FDA-approved and successfully used in medical centers worldwide, each has its own advantages and disadvantages.
Let’s take a closer look at the strengths and limitations of each technique.
🟢 Advantages of VBT
- Preserves spinal mobility, which is valuable for athletes and those engaged in physically flexible activities.
- Provides a more natural posture and appearance, as the spine gradually adjusts with growth.
- Minimally invasive: VBT is typically performed thoracoscopically, leading to quicker recovery.
🔴 Disadvantages of VBT
- Higher chance of revision surgery: The tether can loosen or break, or the correction may shift with growth.
- Not suitable for all cases, especially if the curve is rigid or very severe.
🟢 Advantages of Spinal Fusion
- Provides immediate and lasting correction, with low recurrence risk.
- Suitable for a wide range of patients, particularly those who are done growing.
- Extensively studied, with decades of reliable clinical data.
🔴 Disadvantages of Spinal Fusion
- Reduces flexibility in the fused section of the spine, which may limit certain activities.
- May increase stress on adjacent segments above and below the fused area.
- Open surgery requires longer recovery, compared to VBT.
3. Which Patients Are Candidates?
The success of either technique greatly depends on the patient’s age, spinal flexibility, and growth potential.
When Is VBT a Good Fit?
- Typically used for patients aged 10–16 who still have significant spinal growth remaining.
- Most effective for flexible curves, which can be partially corrected when bending forward.
- Ideal for patients without significant kyphosis and with anatomy suitable for tethering.
- Often preferred by active adolescents concerned with aesthetics and mobility.
When Is Spinal Fusion Preferred?
- Best for patients who have completed most of their spinal growth, usually 15–18 years and older.
- Recommended in severe or stiff curves, where VBT may not achieve desired correction.
- A reliable choice in cases where VBT is not technically feasible or safe.
4. Surgical Approach and Recovery
VBT is usually performed via a thoracoscopic (minimally invasive) approach through small incisions in the chest. The tether is tensioned across the outer curve, and patients typically walk within a few days and return to daily life in just a few weeks.
Spinal fusion involves open surgery. Surgeons insert metal rods and grafts to realign and stabilize the spine. Over time, the vertebrae fuse into one bone. Recovery takes longer: patients may resume daily activity after about 6 weeks, and return to intensive sports within a few months.
5. Mobility and Impact on Daily Life
VBT’s standout benefit is that it preserves motion in the operated area. Activities such as gymnastics, dance, or swimming remain much more accessible.
Fusion surgery, by contrast, eliminates motion in the fused section. This might limit certain sports or positions requiring flexibility. However, for many patients—especially adults or those with less physically active lifestyles—this does not significantly impact quality of life.
6. Long-Term Outcomes and Clinical Evidence
VBT is a relatively newer technique. While mid-term outcomes are promising—especially in appropriately selected patients—it requires careful follow-up throughout the remaining growth phase.
Spinal fusion has been used for decades and remains the gold standard for long-term spinal correction. It is associated with low revision rates and durable outcomes, though long-term stress on nearby segments is a consideration in some cases.
7. The Family Perspective: Making the Right Decision
Choosing scoliosis surgery is more than a medical decision—it also involves psychological, aesthetic, social, and academic factors. For many teens, posture, body image, sports participation, and school timing all play a role.
The surgeon’s guidance is essential, but so is understanding the patient’s lifestyle, values, and goals. VBT may appeal to those prioritizing mobility and aesthetics, while fusion offers a more predictable and lasting solution.
Ultimately, a shared decision-making process with the medical team is key. Every patient is different, and each approach should be carefully personalized with a clear understanding of all options.
