CPT® Code 22837

Anterior thoracic vertebral body tethering (AVT), also referred to as vertebral body tethering (VBT), is a surgical procedure designed to address severe and progressive scoliosis of the thoracic 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 those whose skeletal development is not yet complete. During the procedure, a flexible cord, known as a tether, is strategically placed to facilitate gradual correction of the spinal curvature. The surgical approach involves making three small incisions, each approximately 2.5 cm in length, located in a line beneath the armpit. Through these incisions, endoscopic instruments are introduced to perform the necessary surgical tasks. The procedure includes the placement of anchors and bone screws on the outer side of the spinal curvature, to which the tether cord is secured using additional set screws. By applying tension to the tether cord, the surgeon can partially straighten the spine, and as the patient continues to grow, the tether cord will further guide the vertebrae into a straighter alignment. The duration of the procedure varies, with tether placement for a single curve typically taking between 2 to 3 hours, while procedures addressing double curves may extend to 4 to 6 hours. For coding purposes, CPT® Code 22836 is used for tether placement involving up to 7 vertebral segments, whereas CPT® Code 22837 is designated for procedures involving 8 or more vertebral segments.