Correcting Scoliosis with Surgery

Adolescent Scoliosis Surgery Overview

While non-surgical options for treating scoliosis are obviously preferred, once curves progress to around 45-50°, surgery becomes the best option. Fortunately, patients and their families have some choices to consider these days as they move forward with the best scoliosis correction surgery options for their unique needs.

Vertebral Body Tethering (VBT)

A promising surgical option that has gained traction over the past ten years is vertebral body tethering (VBT). Zimmer Biomet has been a leader in this area. In the past, surgery involved spinal fusion, which could severely limit the movement of patients whose curvature had progressed to a point where surgery was warranted.

With VBT, a process called “growth modulation” is used to treat scoliosis in children who are still growing. Their own growth is used to help repair the curve. As Zimmer Biomet says: “The Tether is almost like an ‘internal brace’ for your spine. It puts pressure on the outside of the curve, allowing the inside of the curve to continue growing. This is what straightens out the spine.”

According to Zimmer Biomet website, the Tether is approved as a Humanitarian Device for patients with idiopathic scoliosis with a Cobb angle of 30-65 degrees. Patients should have failed bracing and/or be intolerant to brace wear. There is probable benefit of the device, but its efficacy is still unproven.

Apifix®

Another non-fusion procedure, ApiFix®, also offers surgery without fusion, while preserving patient motion. This surgical scoliosis correction option uses a self-adjusting rod to help straighten the patient’s spine. Polyaxial joints on the rods allow for a wider range of motion for patients. Recovery time is also significantly shortened with most patients able to return to their normal activities within just a few weeks. The ApiFix® procedure has been performed over 500 times with over 9+ years of clinical experience. The ApiFix device offers a much better range of motion for children who still have not completed bone growth. Your orthopedic surgeon can determine your child’s growth status using x-rays and other indicators. Young people with an ApiFix device can enjoy much greater freedom of movement. Follow-up appointments with your child’s surgeon are mainly to monitor growth and address any questions you have. The surgeon does not need to do anything to lengthen or adjust the device—it naturally expands with your child’s growth. The ApiFix® MID-C System is indicated for treatment of adolescent idiopathic scoliosis (AIS) for treatment of single curves classified as Lenke 1 (thoracic major curve) or Lenke 5 (thoracolumbar/lumbar major curve), having a Cobb angle of 35-60 degrees which reduces to less than or equal to 30 degrees on lateral side-bending radiographs, and thoracic kyphosis less than 55 degrees as measured from T5 to T12.

Spinal Fusion

For some patients, spinal fusion is still the best option for surgical scoliosis correction. Spinal fusion surgery is an option that is often able to improve the degree of the curve and other symptoms related to severe scoliosis. By stabilizing the spine, many people experience reduction in pain and improvement in other areas like organ function, lifestyle and confidence.

With spinal fusion, an orthopedic surgeon or neurosurgeon corrects a curve by using a combination of instruments and implantable devices such as rods, screws and hooks—and sometimes another material called bone graft. These implants are used to hold the spine in a stabilized, straighter position. Your surgeon will select the optimal materials to use, depending on numerous factors including age, severity of curve, rigidity of curve and underlying conditions.

Physicians Explain the Procedures

Dr. Derek Lee, a health and wellness doctor, has interviewed some of the world’s top scoliosis surgeons, driven to a large degree by his own son’s experiences with scoliosis. His goal: to provide reliable information to patients and their children to help them understand the options available to them so they can make informed choices.

Dr. Peter Newton, a spine surgeon and Chief of Orthopedic Surgery at Rady Children’s Hospital in San Diego, shares his perspectives on VBT.

Dr. Noelle Larson, a pediatric spine surgeon at Mayo Clinic, discusses Apifix, VBT and fusion for adolescents with scoliosis.

Important Questions to Ask Your Surgeon

As you, and your child, consider your scoliosis correction surgery options, here are some questions you may want to consider asking your surgeon:

  • What type of surgery will be performed?
  • How long will I be in the hospital?
  • What can I anticipate for recovery?
  • What can be done for pain management?
  • Will I need a brace after surgery?
  • How many of these operations have you performed?
  • Will I be able to resume normal activities with this surgery?
  • What level of correction can I expect in my curve?
  • What are the complication rates?
  • When can I see my child afterwards?
  • Can I stay with my child at the hospital?
  • What will my scar look like?
  • How do I care for the incision?
  • What should my child bring to the hospital?
  • What other doctors will be in the operating room?

Asking your surgeon questions before surgery is very important. It is best to find a surgeon who you feel that you can ask questions openly, discuss fears and worries and feel as though you are listened to. This communication is vital to a successful surgery and recovery.

Commonly Asked Questions

What is Apifix surgery? Apifix surgery is scoliosis correction surgery that does not require fusion, is minimally invasive and uses a rod which gradually expands to grow along with a child’s spine. How much does ApiFix cost? The cost will vary based on each patient’s unique needs. Parents should explore costs with providers as they’re considering surgery options for their children. What is VBT for scoliosis? VBT, or vertebral body tethering, uses a process referred to as “growth modulation” to treat children with scoliosis who are still growing. How long has ApiFix been around? ApiFix has been around since 2011. It was founded in Misgav, Israel by Professor Yizhar Floman. ApiFix was acquired in 2021 by Orthopediatrics, a company exclusively focused on advancing the field of pediatric orthopedics. It is available in the USA, Canada, Europe, Israel, and Singapore. Is VBT surgery FDA approved? The FDA reviewed data for The Tether – Vertebral Body Tethering System through the humanitarian device exemption (HDE) process. A Humanitarian Use Device (HUD) is a device intended to benefit to patients by treating or diagnosing a disease or condition that affects not more than 8,000 individuals in the U.S. per year. The FDA reviewed clinical data supporting the safety and probable benefit of The Tether – Vertebral Body Tethering System from 57 patients who received the device. At two years, 43 patients had sufficient improvement of the curvature of their spines and did not need spinal fusion. The most common serious adverse events observed included overcorrection of the curvature, tether breakage, and pneumothorax or air leakage into the space between the lung and chest wall. General complications consistent with any spinal surgical procedure were also noted including pain, respiratory problems, nerve injuries and bleeding.