Parent Guide: VBT Scoliosis Surgery — Vertebral Body Tethering

Vertebral Body Tethering — VBT — is a modern surgical method for correcting idiopathic scoliosis in children and adolescents without spinal fusion. During the procedure, special screws are placed into the vertebral bodies on the convex side of the curve and connected with a strong flexible tether.

VBT can be compared to an internal dynamic brace. It corrects the spinal curve while preserving spinal mobility, unlike traditional spinal fusion surgery, where the vertebrae are rigidly fixed together.

Schematic illustration of dynamic scoliosis correction

Who Is Suitable for VBT Surgery

VBT was developed for children and adolescents with idiopathic scoliosis whose spinal growth has not yet finished.

The most suitable candidates are:

children usually aged from 9–10 to 15–16 years
progressive scoliosis with a curve of approximately 30 to 60 degrees
remaining growth potential
no congenital vertebral abnormalities or neuromuscular disease

How the Preliminary Evaluation Is Performed and How the Decision Is Made

The evaluation begins with an analysis of standing spine X-rays. The doctor assesses not only the Cobb angle, but also the shape of the curve and its flexibility in order to understand how well the spine can be corrected. The progression of the condition is also important. If the curve continues to increase despite bracing or observation, this indicates progression and may require surgical treatment. If the situation remains stable, continued observation may be possible.

The key factor is the child’s remaining growth. VBT is effective only when growth potential is still present. If growth is almost complete, the effect of VBT will be limited. In many cases, the first assessment can be performed remotely. After reviewing the scans and medical documents, the surgeon provides a preliminary opinion. The final decision is made after an in-person examination at the clinic.

Preparing the Child and Family for Surgery

Preparation for surgery is not only a medical process, but also an emotional one, especially for the child and parents. The calmer and more confident the family feels, the easier treatment and recovery usually become.

A few days before surgery, the child undergoes standard tests to confirm that they are ready for anaesthesia and surgery. These usually include blood tests, an electrocardiogram, and an anaesthesiologist consultation. The doctor explains in detail how the operation will be performed and answers the parents’ questions.

It is very important to speak with the child in advance about the upcoming treatment. The explanation should be honest, calm, and easy to understand. The child should know that the operation is needed to help the spine grow straighter and healthier.

There is no need to use frightening words or excessive detail. It is enough to explain that the doctors will do everything to help, and that the parents will be nearby.

The day before surgery, the child must stop eating and drinking so that anaesthesia can be performed safely. This may cause anxiety, but the medical team supports the family and explains every step.

Parents are usually allowed to stay close until the child falls asleep under anaesthesia. This is a stressful moment for the family, but it is important to remember that the operation is planned, performed under controlled conditions, and the medical team is experienced with this technique. Parental calm helps the child feel protected and confident.

How VBT Surgery Is Performed

VBT surgery is performed under general anaesthesia. This means the child will be asleep and will not feel pain during the procedure.

Before the operation begins, the anaesthesiologist checks the child’s condition once again and monitors all vital signs throughout the procedure.

Access to the spine is made through small incisions on the side of the chest or in the lumbar region. The exact approach depends on where the scoliosis curve is located. These incisions are much smaller than in traditional spine surgery and help reduce surgical trauma.

During the operation, the surgeon places screws into the vertebral bodies on the convex side of the curve. A flexible tether is then passed through these screws and carefully tightened. At this stage, the spine is partially corrected directly on the operating table.

The tension is calculated very precisely. The surgeon deliberately does not aim for complete correction immediately, leaving the spine the possibility to continue straightening gradually as the child grows.

Special neuromonitoring is used throughout the operation. It allows the team to continuously monitor the function of the spinal cord and nerves and serves as an additional safety measure.

On average, the operation takes several hours. After the procedure is completed, the child is transferred to an intensive observation unit, where they wake up under the supervision of medical staff.

The First Hours and Days After Surgery

mmediately after surgery, the child is closely monitored by doctors. During the first hours, the main focus is on breathing, pain control, and the general condition. Pain after surgery is expected, but it is actively controlled with modern pain medication so that the child feels as comfortable as possible. During the first 24 hours, the child may feel weak, sleepy, and uncomfortable when moving or taking deep breaths. This is a normal reaction to surgery and anaesthesia. The medical team helps the child change position in bed and explains how to breathe correctly so that the lungs expand well.

One or two days after surgery, the child begins to get up carefully. First, they sit up in bed, then take the first steps with support. Early movement is important for recovery and helps prevent complications. Most children begin walking independently around the hospital room within the first few days. Nutrition is restored gradually. First, the child is allowed to drink water, then light food. As the child feels better, they return to a normal diet. Parents are usually nearby throughout this period, which helps the child feel calmer and more secure.

Discharge from the Clinic and the First Weeks at Home

By the time of discharge, the child’s condition is usually stable. They can usually stand, walk, and eat normal food independently. The doctor examines the surgical wounds, assesses the general recovery, and explains to the parents how to care for the child at home. The incisions after surgery are usually small and heal relatively quickly. During the first weeks, it is important to keep the skin around them clean and dry.

Bathing is usually postponed until the wounds have fully healed, but showering may be allowed after a few days if the doctor approves. Parents are given detailed instructions on which signs to watch for and when to contact the clinic. During the first days at home, the child may get tired more quickly and may need help with daily activities. This is normal. The body is recovering after a serious procedure, and activity should be increased gradually. Walking is allowed and even useful, but sudden movements, bending, and lifting heavy objects are temporarily restricted.

Pain medication is usually continued as prescribed by the doctor, but the need for it decreases day by day. Most children notice significant improvement and reduced pain within one to two weeks. It is important to follow the doctor’s recommendations and not rush the recovery, even if the child feels better.

Returning to School and Daily Activity

Return to normal life happens gradually. During the first weeks after surgery, the child needs more rest and should avoid overloading themselves. Returning to school is usually possible after two to four weeks, depending on the child’s condition and the doctor’s recommendations. At first, sitting in one position for a long time may be difficult. Short breaks are helpful so the child can stand up and move a little.

The backpack should not be heavy. Physical education and active games are temporarily restricted until the specialist gives permission. As recovery progresses, the child becomes more confident in movement. After a few months, most children return to normal daily activity without major restrictions.

One of the important advantages of VBT is that spinal mobility is preserved, allowing the child to gradually return to activities they enjoy, such as walking, swimming, or sports. Parents should remember that recovery is a process, not an immediate result. Even if the child looks well externally, the spine needs time to adapt to the changes. A calm pace and family support help make this period as comfortable and safe as possible.

Long-Term Recovery and Spinal Growth

After VBT surgery, the child’s spine continues to grow and gradually straighten. This process takes months and sometimes years, so it is important to understand that the final result does not appear immediately. Over time, posture usually becomes more balanced, and asymmetry of the shoulders and trunk may decrease. During the growth period, the child usually returns to active life faster than after traditional spinal fusion surgery. Mobility is preserved, and movement is not limited by rigid fixation, which makes adaptation to daily activities easier.

As recovery progresses, the doctor may recommend physiotherapy exercises aimed at strengthening the back muscles and maintaining proper posture. Physical activity returns gradually. First, this includes walking and light exercises, followed later by more active activities. In the future, most children can take part in sports without major restrictions. Preserving spinal mobility is considered one of the main advantages of VBT and an important factor for future quality of life. It is important to remember that every child recovers at their own pace. Some children grow faster, others more slowly.

The role of the parents is to support the child, follow the doctor’s recommendations, and avoid comparing their child’s recovery with others.

Follow-Up Examinations Until Growth Is Complete

Regular follow-up is important after surgery. Follow-up visits allow the doctor to assess how the spine is responding to treatment and how the curve is changing as the child grows. During these visits, X-rays and clinical evaluation are performed. The doctor checks the position of the implants and the degree of correction in order to notice any changes in time and adjust the treatment plan if needed. In many cases, follow-up can be performed remotely. Parents send X-rays to the doctor, which is especially convenient for families who travelled abroad for treatment. If needed, the child is invited for an in-person examination. Follow-up continues until spinal growth is complete. If the result remains stable, frequent monitoring is usually no longer required.

Possible Risks and Further Decisions

VBT is a modern and generally safe method of scoliosis correction, but like any surgical procedure, it is not completely free of risks. In the first days after surgery, pain and tiredness are possible. These are usually well controlled with medication and gradually decrease. In the longer term, the outcome depends on spinal growth. Sometimes correction may be insufficient or, on the contrary, excessive. This is why regular follow-up after VBT is important until the child has finished growing. In rare cases, an additional procedure may be required, but for most children one operation is sufficient.

What the Family Should Remember

VBT surgery is not an instant solution, but a process that develops over time. The main correction happens gradually as the spine continues to grow. Patience and following the doctor’s recommendations play a key role in achieving a good result. Family support helps the child go through treatment and recovery more easily. Parental calm, trust in the medical team, and understanding of the treatment stages reduce anxiety and make the process more predictable. In most cases, children after VBT return to an active life with preserved spinal mobility and good quality of life.