Scoliosis Drawstring System
One of the most groundbreaking advances in scoliosis treatment in recent years is Vertebral Body Tethering (VBT), also known as the “Tether System” or “Fusionless Scoliosis Surgery”. Unlike traditional fusion (freezing) surgery, this innovative technique aims to preserve the patient's movement and flexibility while correcting the curvature of the spine. Prof. Dr. Mehmet Tezer successfully applies this advanced surgical technique in appropriate patient groups in parallel with current practices in the world.
What is Scoliosis Tethering (Vertebral Body Tethering)?
Rope scoliosis surgery is a surgical method that corrects the curvature by using a flexible tether instead of fixing and freezing the spine with metal rods (fusion). In this technique, screws are inserted thoracoscopically (closed) into the vertebrae on the convex side of the curve. A very strong and flexible string made of polyester material is passed through the heads of these screws. The string is stretched in a controlled manner and the curvature is immediately corrected to some extent. Since the vertebrae are not fused together, the natural growth and mobility of the spine is preserved.
How Does This Method Work?
The working principle of the drawstring system is that it turns the child's remaining growth potential into a therapeutic tool. While the string suppresses (slows down) the growth of the vertebrae on the longer convex side of the curve, the growth of the shorter concave side continues in its natural course. Over time, as the child grows taller, the spine continues to straighten on its own thanks to this “directed growth”. Therefore, this method is considered a “growth-friendly” surgery and the curvature is expected to improve over time.
What are the Advantages of Traditional Fusion Surgery?
The most important advantages of the drawstring system over conventional fusion surgery in the appropriate patient group are as follows:
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Protection of Movement: Since the spine is not frozen, patients can continue to perform movements such as bending forward, backward and sideways.
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Faster Recovery: Postoperative recovery and return to normal life is usually faster and more comfortable than with fusion surgery.
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Early Return to Sport: It is an important advantage especially for active and athletic young people. Patients can usually return to sports in as little as 6-8 weeks.
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Growth Friendly Approach: It does not interfere with the growth of the spine and the child's height.
Who is a Suitable Candidate for Thread Scoliosis Surgery?
This innovative method is not suitable for all scoliosis patients and patient selection is critical. The most ideal candidates for thread scoliosis surgery;
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Continued bone growth (incomplete skeletal development),
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Usually between 35 and 65 degrees,
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Having a flexible curvature of the spine idiopathic scoliosis are patients.
Your spine surgeon will decide whether you are suitable for this procedure after a detailed examination and X-ray analysis.
Frequently Asked Questions
No, it is not experimental. Vertebral Body Tethering (VBT) is a procedure with a history of approximately 10-15 years, proven efficacy and safety, and recognized by international authorities such as the US Food and Drug Administration (FDA). However, it is a "new generation" technology compared to traditional fusion (freezing) surgery, which has a history of over 100 years. Therefore, very long term results of 20-30 years are still accumulating.
The rope used in the surgery is made of a very strong and flexible medical polymer material called "polyethylene terephthalate", which is fully compatible with the body. This material has been used safely in other orthopedic surgeries for years.
Years after the surgery, especially if the patient is very active, a risk of rupture is available. This risk is low but not zero. If the rupture occurs after the child has finished growing and the curve has stabilized, it usually does not cause any problems and does not require additional intervention. However, if the rupture occurs during a period of active growth, there may be some loss of curvature and a second surgery to replace the ligature may be required.
Yes, these are the most important and manageable risks of the growth modulation technique.
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Over-correction: If the child has the potential to grow more than expected, or if the string tension is set too high, the curve may start to turn in the opposite direction. This is monitored by regular X-ray follow-up and, if necessary, may require a minor intervention to loosen or remove the string.
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Under-correction: If the curve is too rigid or the child's remaining growth potential is too low, the targeted correction may not be achieved. However, it is still considered a success if the progression of the curve is stopped and the curve is reduced to acceptable limits.
The available 10-year follow-up studies show that the method is successful in correcting and maintaining the curvature and, most importantly, preserving spinal mobility. However, unlike fusion surgery, revision (a second operation) is more likely with the threaded system. There is a possibility of a second surgery for reasons such as thread breakage, overcorrection or to switch to fusion surgery if necessary in the following years. Patients should be aware of this potential risk of revision in exchange for preserving motion.
Fusion surgery is still the "gold standard" of scoliosis surgery because it can be performed at any age, in any type and degree of curvature, with very predictable and durable results. The drawstring system is only to a specific and narrow group of patients is suitable. The following patients are good candidates for the drawstring system is not:
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Patients who have completed or are very close to completing bone growth.
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Those whose curvature is very hard (rigid).
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Very large curvatures above 65-70 degrees.
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Patients who also have a pronounced hump (kyphosis) of the spine.
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Non-idiopathic (neuromuscular, congenital) types of scoliosis.
The purpose of this method is to functionally to function as close to normal as possible. Although the postoperative spine is not completely anatomically "normal" due to the screws and thread, patients can bend, rotate and play sports as if they had a normal spine because mobility is preserved. In fusion surgery, a part of the spine is permanently immobilized. This is the biggest difference and advantage of the drawstring system.