Anterior Lumbar Vertebral Body Tethering in Adolescent Idiopathic Scoliosis Surgical/Technical Tips

Abstract

Adolescent idiopathic scoliosis (AIS) is the most common spinal deformity in children. The traditional treatment for curves greater than 50 degrees is posterior spinal fusion with pedicle instrumentation for prevention of curve progression later in life. However, there is growing interest in non-fusion techniques such as anterior vertebral body tethering. Despite the common presentation of thoracolumbar and lumbar curves in AIS, descriptions of anterior vertebral body tethering for AIS have been largely limited to the thoracic vertebrae. The goal of this paper is to describe the technique of lumbar anterior vertebral body tethering which involves a combined thoracoscopic and mini-open approach to the spine with a transdiaphragmatic tether. The technique and reduction are aided by CT navigation and a radiolucent hinged spine surgery table. Dissemination of successful techniques is essential to advance non-fusion care for idiopathic scoliosis.