Spinal tethering, also known as vertebral body tethering (VBT), is a relatively new, growth-modulating technique that corrects scoliosis and other spinal deformities without the need for traditional fusion. The procedure involves attaching a flexible, high‑strength polymer cord to the convex side of the curve through small thoracoscopic or mini‑open incisions. By applying a controlled, asymmetric tension to the tether, the surgeon harnesses the patient’s natural growth potential to gradually remodel the spine, encouraging the vertebrae on the concave side to catch up while limiting further progression of the curve on the convex side. Because the tether remains flexible, the spine retains a degree of motion, preserving thoracic flexibility and reducing the long‑term risk of adjacent‑segment degeneration that is often seen after fusion.

Candidate selection is critical: VBT is most effective in skeletally immature patients (typically Risser 0‑2) whose curves are moderate (generally 30°–65°) and demonstrate continued growth. Pre‑operative imaging, including standing radiographs and MRI, helps confirm that the deformity is primarily structural and that there are no contraindicating pathologies such as severe vertebral rotation or rigid ankylosis. Intra‑operatively, the surgeon places screws into the vertebral bodies along the curve and threads the tether through a specialized tensioning device, allowing real‑time adjustment of correction while monitoring neuromonitoring signals to safeguard spinal cord integrity.

Clinical studies to date show that VBT can achieve comparable coronal correction to fusion in appropriately selected patients, with the added advantage of preserving spinal motion. Most patients report rapid postoperative recovery, a shorter hospital stay, and a return to low‑impact activities within weeks. Long‑term data are still accruing, but early evidence suggests a low incidence of revision surgery and a favorable safety profile. As the body of research grows, Spinal Tethering Surgery is poised to become an important option for adolescents and young adults seeking curve correction without the permanent loss of spinal mobility inherent to fusion techniques.