CPT® Code 0657T

Anterior lumbar or thoracolumbar vertebral body tethering (AVT), also referred to as vertebral body tethering (VBT), is a surgical procedure designed to address severe and progressive scoliosis affecting the lumbar or thoracolumbar regions of the spine. This technique serves as an alternative to traditional spinal fusion, allowing for the correction of spinal deformities while preserving the natural growth and mobility of the spine. The procedure is specifically indicated for children and adolescents who possess sufficient growth potential, making it a suitable option for younger patients whose spines are still developing. During the procedure, a flexible cord or cable is strategically placed to facilitate gradual correction of the scoliosis. The surgical approach involves making two small incisions, typically measuring 2.5 cm, located over the 10th rib and the L3-L4 intervertebral disc. Through these incisions, endoscopic instruments are introduced to perform the necessary surgical steps. The procedure includes the placement of anchors and bone screws on the outer side of the spinal curvature, followed by the securing of the tether cord to these screws using additional set screws. The surgeon then applies tension to the tether cord, which initiates a partial straightening of the spine. As the patient continues to grow, the tether cord will further guide the vertebrae into a straighter alignment, promoting ongoing correction of the spinal curvature. The duration of the procedure varies, with single curve corrections typically taking two to three hours, while double curve corrections may extend to four to six hours. In cases where both thoracic and lumbar curves are present, instrumentation at the T12 vertebral body is required from both sides to ensure effective tethering.