CPT® Code 22836

1. Indications

The procedure of anterior thoracic vertebral body tethering (AVT) is indicated for specific conditions related to spinal deformities. The following are the explicitly provided indications for performing this procedure:

• Severe, progressive scoliosis - This condition involves a significant curvature of the spine that worsens over time, necessitating intervention to prevent further complications.
• Children and adolescents with growth potential - AVT is specifically indicated for younger patients who have not yet completed their skeletal growth, allowing for continued spinal development post-procedure.

2. Procedure

The anterior thoracic vertebral body tethering procedure involves several critical steps to ensure effective correction of scoliosis. The following procedural steps are outlined:

• Step 1: Incision Placement - The surgeon begins by making three small incisions, each approximately 2.5 cm in length, located in a line beneath the armpit. These incisions provide access to the thoracic spine while minimizing tissue damage and promoting quicker recovery.
• Step 2: Insertion of Endoscopic Instruments - Through the incisions, endoscopic instruments are inserted to facilitate the surgical procedure. This minimally invasive approach allows for enhanced visualization and precision during the operation.
• Step 3: Placement of Anchors and Bone Screws - The surgeon places anchors and bone screws on the outer side of the spinal curvature. These devices are critical for securing the tether cord and ensuring stability during the correction process.
• Step 4: Securing the Tether Cord - A flexible tether cord is then secured to the bone screws using set screws. This tether is essential for applying tension to the spine, which aids in the gradual correction of the curvature.
• Step 5: Application of Tension - The surgeon applies tension to the tether cord, which partially straightens the spine. This step is crucial as it initiates the corrective process, allowing the spine to begin aligning more closely to its natural position.
• Step 6: Monitoring and Adjustment - Throughout the procedure, the surgeon monitors the alignment and tension of the tether to ensure optimal placement and effectiveness. Adjustments may be made as necessary to achieve the desired outcome.

3. Post-Procedure

After the anterior thoracic vertebral body tethering procedure, patients can expect specific post-operative care and recovery considerations. It is essential to monitor the surgical site for any signs of infection or complications. Patients may experience some discomfort and will likely be prescribed pain management strategies to aid in recovery. Physical therapy may be recommended to help restore mobility and strength in the spine as healing progresses. The tether cord will continue to guide the vertebrae into a straighter position as the patient grows, necessitating regular follow-up appointments to assess spinal alignment and overall progress. The duration of recovery can vary based on individual factors, but patients are generally advised to avoid strenuous activities during the initial healing phase to ensure optimal outcomes.