Scoliosis tethering surgery—often referred to as vertebral body tethering (VBT)—represents a paradigm shift in the management of adolescent idiopathic scoliosis, moving away from the static correction afforded by posterior spinal fusion toward a dynamic, growth‑modulating strategy. The technique involves the placement of a flexible, polyether‑ether‑ketone (PEEK) cable along the convex side of the scoliotic curve, anchored to the vertebral bodies with specially designed screws. As the patient’s spine continues to grow, the tether exerts a corrective force that gradually straightens the curve while preserving motion at the involved segments. This contrasts sharply with fusion, which arrests growth and eliminates rotational mobility, potentially leading to adjacent‑segment degeneration and a reduced quality of life in the long term.

Clinical indications for VBT are limited to skeletally immature patients—typically those with a Risser grade ≤ 2 or a Sanders bone age ≤ 5—who present with moderate, flexible curves (generally 45°–65°) and a clear potential for continued growth. Pre‑operative planning relies on three‑dimensional imaging, flexibility testing, and detailed assessment of pulmonary reserve, given that the procedure is most advantageous for thoracic curves where preserving thoracic expansion is paramount. Intraoperatively, a minimally invasive thoracoscopic or mini‑open approach is employed, mitigating soft‑tissue trauma and facilitating rapid postoperative recovery.

Outcomes reported in peer‑reviewed series and multicenter registries indicate that VBT can achieve a mean curve reduction of 30°–45° at two‑year follow‑up, with most patients maintaining or improving their sagittal alignment. Importantly, because the tether allows continued spinal growth, patients often exhibit near‑normal spinal biomechanics and a lower incidence of adjacent‑segment disease compared with fusion cohorts. Complications—such as over‑correction, tether breakage, or screw loosening—remain infrequent but necessitate vigilant postoperative monitoring and, in select cases, revision surgery.

In summary, Scoliosis Tethering Surgery offers a growth‑modulating alternative to fusion for appropriately selected adolescents, aligning surgical correction with the natural developmental trajectory of the spine. Ongoing longitudinal studies are expected to refine patient‑selection criteria, optimize tether tensioning protocols, and further elucidate the long‑term functional benefits of this innovative approach.