Understanding Spinal Tethering Surgery: An Overview by John Asghar MD

Spinal tethering surgery is an innovative spinal correction technique primarily aimed at treating adolescent idiopathic scoliosis (AIS) while preserving the patient’s spinal flexibility. Traditional surgical methods often required the use of rigid rods and fusion techniques, which led to decreased mobility and further life changes for the patient. However, with advancements in surgical techniques and technology, spinal tethering has emerged as a viable option for many adolescent patients.

What is Spinal Tethering Surgery?

Spinal tethering involves the implantation of a flexible cord (or tether) on the exterior of the spine. This tether—often made from high-strength synthetic materials—works to correct spinal curvature by applying gradual pressure to the spine, encouraging it to straighten over time. Unlike conventional spinal fusion surgeries, spinal tethering allows for continued growth of the spine, thus minimizing the long-term impact on mobility and flexibility.

The Ideal Candidates

The optimal candidates for spinal tethering are typically adolescents experiencing moderate to severe scoliosis whose bones are not yet fully developed. Physician assessment will focus on both the degree of curvature (often measured by cobb angle) and the potential for spinal growth. The ideal age for this procedure is often around 10 to 15 years old, as this is the time when scoliosis curvature tends to progress.

Advantages of Spinal Tethering

1. Maintained Flexibility: One of the significant advantages of this procedure is that it preserves spinal mobility and flexibility. Patients can continue participating in activities like sports without the limitations imposed by spinal fusion.

2. Less Invasive: Compared to rigid fusion surgeries, spinal tethering is less invasive, can often be performed with smaller incisions, and may lead to shorter recovery times.

3. Gradual Correction: Tethering allows for gradual curvature correction, as the tether works in tandem with the body’s natural growth processes. In many cases, the tether can be adjusted to match the spine’s development over time, ensuring optimal results.

4. Reduced Need for Revision Surgeries: As traditional fusion surgeries can often lead to degenerative changes in adjacent segments of the spine, tethering reduces the likelihood of additional surgeries later in life.

The Surgical Procedure

The spinal tethering procedure is typically performed under general anesthesia and follows several essential steps:

1. Anesthesia and Preparation: The patient is placed under general anesthesia, a standard practice for such operability. The surgical team then prepares the area with antiseptic solutions.

2. Incision: A small incision is made, usually along the back over the affected vertebrae, which allows for direct access to the spine.

3. Exposure and Dissection: The muscles and tissues surrounding the spine are gently dissected away, exposing the vertebrae affected by scoliosis.

4. Tether Placement: The tether is custom-fitted to the length of the spine’s curvature and attached to the bony structures on the exterior of the vertebrae. The attachment points are securely fixed, allowing the tether to influence growth direction as the patient continues to grow.

5. Closure: After the tether is placed and everything is appropriately positioned, the layers of tissue are carefully closed, and the incision is sutured shut.

6. Recovery Room: The patient is moved to a recovery room where they are closely monitored as they regain consciousness from anesthesia.

Recovery and Rehabilitation

Post-surgery, patients typically stay in the hospital for a brief period (usually 1-3 days). Discomfort and pain management are crucial during this phase, and patients can expect a gradual return to activities. Physical therapy plays an integral role in recovery, focusing on strengthening exercises specifically tailored to support the spine.

Doctors will often schedule follow-up appointments to monitor the progress of the tether and the spine’s growth. X-rays will be performed periodically to assess curvature changes and ensure the tether is functioning as planned.

Risks and Considerations

As with any surgical procedure, spinal tethering is not without risks. While the incidence of complications is relatively low, potential risks include:

• Infection: As with any surgery, there is a risk of infection at the incision site or deeper surgical site.

• Implant Failure: In rare cases, there may be issues with the implant’s integrity over time, necessitating further intervention.

• Nerve Damage: There is a minimal risk of nerve injury during the procedure, leading to numbness, pain, or motor dysfunction.

• Non-Union: If the tether does not function correctly, it may fail to stabilize the spine adequately.

Patients considering spinal tethering should engage in thorough conversations with their medical professionals to understand both the benefits and risks involved.

Conclusion

Spinal tethering surgery represents a significant leap forward in the treatment of scoliosis for adolescents and is part of the broader movement toward less invasive and more flexible spinal correction methods. By allowing for the preservation of spinal mobility and ongoing natural growth, this technique has the potential to improve quality of life for young patients facing the challenges of scoliosis.

For those navigating the complex decisions around adolescent scoliosis treatment, consulting with specialists like John Asghar MD can provide crucial guidance and support, paving the way for informed choices and optimal outcomes. Our commitment is to provide comprehensive solutions that blend innovation with compassionate care to help patients achieve their best possible futures.