This Service is currently evaluating whether this procedure should be added to the operations we perform. This procedure is being discussed at our National meeting – The British Scoliosis Society in Cardiff 21st and 22nd November 2019. This page will be updated after that.
U.K. National position – end November 2018.
In the U.K. the main group of surgeons and other health professionals considering this technique are the British Scoliosis Society (BSS). At the 42nd annual society meeting in Belfast late November 2018 a further debate and information was shared on AVBT. This included information from Scoliosis Association U.K. with a survey of 62 U.K. patients that included 4 with the potentially life threatening complication of major bleeding during surgery. The BSS society will update the U.K. position statement by early 2019 and place it on the web site. At present NHS England are running a public consultation that closes 10/01/2019. There is no approval for a research study in the U.K. at time of writing with submissions due early 2019 that include the British Scoliosis Research Foundation (BSRF). This service is looking to contribute.
Scottish National Spine Deformity Service position 21/12/2018.
Two of the surgeons from this Service travelled to see one of our patients who decided to have the surgery at Shriners Hospitals for Children – Philadelphia in April 2017. This could not have gone better for the patient, parents or for us as representatives of our big team. The Shriners team made us so welcome with their attitude of caring and attention to detail inspirational. They have offered to mentor and collaborate with us as a Service. The early result below of this patient with this featuring on the BBC in May 2017.
Before
Before
After
After
The operation is supposed to be limited to young teenagers who have their adolescent growth spurt ahead of them. It is for patients who have failed brace treatment and wish an operation. This new procedure is instead of the standard and usual fusion operation with rigid rods. Of the total patients who are having fusion surgery in this Service we estimate that less than 20 people would be candidates for this option each year.
The operation is done through the side of the chest. Surgeons use one of two methods: either ‘key hole’ using a video camera and screen or a small open cut, both with x-rays. Surgeons place screws into the spinal bones (vertebrae) that are joined by a plastic band – the tether. This tether corrects the abnormal spine shape of scoliosis straight away. Over the next few months with further growth the hope is more correction guided by the tether. The main theoretical advantage is to preserve spine movement. The outcome beyond a few years is not known.
We are working hard to evaluate and potentially introduce the new procedure of Anterior Vertebral Body Tethering (AVBT). This has been developed since 2012 at Shriners Hospitals for Children – Philadelphia, U.S.A.. Our aim is to safely implement being providers of this surgical technique in the future if possible. We are working with NHS National Services, NHS Lothian, NICE, the British Scoliosis Society and others to move this forward.
