In favor of coverage for vertebral body tethering in immature kids, the Scoliosis Research Society and the Pediatric Society of North America have issued a joint statement supporting the range for the procedure. When dealing with patients that you believe will benefit from vertebral tethering (vertebral fusion), insurance companies.
Scoliosis is an abnormal curvature of the spinal column that occurs on both sides and rotates. AIS (adolescent idiopathic scoliosis) is the most common form of adolescent idiopathic scoliosis, which is defined by the United States Preventive Services Task Force as “a lateral curvature of the spine with onset at or before the age of 10 years, no underlying cause, and a risk for progression during puberty.”
It is referred to as idiopathic since it has no known etiology. However, clinicians believe that asymmetric growth, genetic variance, hormone imbalance, and muscular imbalance may be factored in developing this condition. Curvature progression during periods of rapid growth can end in deformity, which is often complicated by cardiovascular and pulmonary problems. Coverage Rationale
Vertebral body tethering for the therapy of scoliosis is unproven and not medically necessary due to insufficient evidence of safety and efficacy.
Because of the HDE approval terms, the FDA-approved Anterior Vertebral Body Tethering (AVBT) system is restricted to curves between 30 and 65 degrees in skeletally immature patients with idiopathic scoliosis. It can only be used in patients by surgeons with active IRB approval.
Even though the FDA did not demand a more detailed definition of “skeletal immaturity,” we suggest that the term should be similar to those used for bracing indications to avoid confusion. The Scoliosis Research Society defines skeletally immature patients as those with Risser 2 or less or Sanders 5 or less because, according to current understanding, growth modulation is dependent on meaningful residual skeletal development. Procedure for Tethering the Vertebral Column
The spine and orthopedic surgeons at the University of California, San Francisco (UCSF) have considerable experience in vertebral tethering procedures. Dr. Mohammed Diab, a UCSF professor and vice president for research, collaborated with colleagues from chosen medical centers around the country to create this surgical approach.
The University of California in San Francisco pioneered this operation, and the ropes used are approved by the FDA. The success of the treatment is determined on a case-by-case basis for each patient.
A rope or spinal cable is put between the spine and the skull to straighten the spine and bring it into a more natural position. To achieve the optimum results from the vertebral tethering operation, the infant must be growing at the treatment time.
It allows for mobility in all other directions since the tether wire prevents stretching in the convex growth direction. Usually, five or six incisions are made along a single side of the body to secure the rope, and a child’s arm commonly buries these to prevent the string from being seen.
The tethering technique uses the body’s natural development mechanism to straighten the spine. It is only effective in youngsters whose bones are still forming at the time of application. If the curve is too severe, it may cause the spinal curve to be overcorrected. Young children who have only slight scoliosis may not be appropriate candidates for the tethering operation because of their age and physical development.
The use of this product is also not suggested for youngsters older than 14. Therefore, it is preferable to begin the treatment when your child is still growing so that the curvature does not become more noticeable as the child grows.
Is insurance coverage for vertebral body tethering available?
Understandably, you might be concerned about whether vertebral body tethering is covered by insurance if your child has a severe bend in their spine. The operation is regarded to be minimally invasive and does not necessitate the use of surgical instruments.
It is carried out by tying a short rope-like cord to your child’s spine and pulling it tight. This will alter how your child’s spinal growth develops, and it is frequently covered by health insurance.
Important to note is that the Scoliosis Research Society and the Pediatric Society of North America produced a position statement in favor of vertebral tethering in young patients, which can be found here.
Vertebral tethering for kids with an immature curvature in their spine is supported by the Scoliosis Research Society, which comprises pediatric surgeons and orthopedic surgeons who work together on research projects.
Tethering is recommended by the Scoliosis Research Society and the Pediatric Society of North America, and it should be covered by health insurance.
The Cost of Vertebral Body Tethering
Vertebral body tethering is a costly treatment for youngsters, but it is well worth it in the long term. The procedure will be performed under thoracic anesthesia, and the child will be placed to sleep and evaluated every six months until the curve has been eliminated.
A series of X-rays will be taken of the youngster to establish the amount of the curvature. The tethering is permanent, and it will remain in the child’s spine for the rest of their life.
The operation is quite effective, but it comes with a high price, often prohibitive for most people. Two to three hours are required for the procedure, carried out under general anesthesia. It is carried out while the patient is restrained by a rope fastened to the spine with bone screws and a flexible cord threaded through the screws.
A patient must have idiopathic scoliosis to be considered for VBT surgery. The curvature of the spine must be less than 65 degrees to be considered normal. The patient’s lungs will be deflated during the surgery, but they will be reinflated after the procedure is over. It is usual for the patient to suffer soreness and discomfort following surgery. During the next couple of days, coughing and breathing will be difficult. Following the treatment, the chest tube will be withdrawn, which should alleviate any postoperative pain that may have occurred. On the other hand, the young patient should be able to return to normal activities within six weeks