CPT® Code 0657T

1. Indications

The procedure of anterior lumbar or thoracolumbar vertebral body tethering (AVT) is indicated for specific conditions and patient demographics. The following are the primary indications for performing this procedure:

• Severe Scoliosis The procedure is indicated for patients with severe, progressive scoliosis affecting the lumbar or thoracolumbar spine.
• Growth Potential AVT is specifically designed for children and adolescents who have sufficient growth potential remaining, making it suitable for younger patients.

2. Procedure

The anterior lumbar or thoracolumbar vertebral body tethering procedure involves several critical steps to ensure effective correction of scoliosis. The following outlines the procedural steps:

• Step 1: Incision Creation The procedure begins with the surgeon making two small incisions, each approximately 2.5 cm in length. One incision is made over the 10th rib, and the other is positioned over the L3-L4 intervertebral disc. These incisions provide access to the spine while minimizing tissue damage.
• Step 2: Instrumentation Insertion Through the incisions, endoscopic instruments are inserted to facilitate the surgical procedure. This minimally invasive approach allows for better visualization and manipulation of the spinal structures.
• Step 3: Anchor and Screw Placement The surgeon then places anchors and bone screws on the outer side of the spinal curvature. This step is crucial for securing the tether cord and ensuring that it can effectively guide the vertebrae into a straighter position.
• Step 4: Tether Cord Securing After the anchors and screws are in place, the tether cord is secured to the bone screws using additional set screws. This connection is vital for the tensioning process that follows.
• Step 5: Tension Application The surgeon applies tension to the tether cord, which initiates a partial straightening of the spine. This tension is critical for the immediate correction of the spinal curvature.
• Step 6: Growth Adjustment As the patient continues to grow, the tether cord will gradually straighten the spine further by guiding the vertebrae into a more aligned position. This ongoing correction is a key benefit of the tethering technique.
• Step 7: Duration of Procedure The total time required for the procedure varies based on the complexity of the curvature. A single curve correction typically takes two to three hours, while a double curve correction may require four to six hours. In cases involving both thoracic and lumbar curves, instrumentation at the T12 vertebral body is applied from both the left and right sides to ensure comprehensive tethering.

3. Post-Procedure

Post-procedure care for patients undergoing anterior lumbar or thoracolumbar vertebral body tethering involves monitoring for any complications and ensuring proper recovery. Patients are typically observed for a period following the surgery to assess their response to the procedure and to manage any pain or discomfort. Rehabilitation may be initiated to promote mobility and strengthen the surrounding musculature. Follow-up appointments are essential to monitor the progression of spinal correction and to make any necessary adjustments to the tethering system as the patient grows. The expected recovery time can vary based on individual patient factors and the extent of the procedure performed.