Crawford Spine Center

Patient Stories | Logan and Vertebral Body Tethering

Successful Non-Fusion Spine Surgery and Custom Physical Therapy Regimen Helps Correct Logan’s Scoliosis

At first, the pediatrician didn’t seem too concerned. He thought Logan’s spine might be “a little off” due to recent growth spurts and recommended a spinal X-ray during his annual well visit.

“It was just to get a baseline the doctor said. But once we got the X-ray taken, it didn’t take someone with a medical degree to see the curve,” said his mom, Amy. 

Logan, an active 16-year-old who played golf and tennis, was diagnosed with severe idiopathic scoliosis. He had a confirmed 47-degree curve in his spine. His parents, Amy and Matt, were shocked by his diagnosis and had many questions. 

Ranging from the types of surgical options available to expected length of time for recovery, their questions also touched on a patient’s quality of life after surgery. But there was never a question as to where Logan would go for treatment. 

“It’s the No. 1 children’s hospital in the United States. Why wouldn’t we go to Cincinnati Children’s? We’re lucky to live close to such an amazing hospital,” said Amy.

Finding the Right Surgery for Logan: Spinal Fusion vs. Vertebral Body Tethering (VBT)

In late summer of 2022, Logan and his parents came to Cincinnati Children’s and met pediatric orthopaedic surgeon Peter Sturm, MD, director of the Crawford Spine Center. Bracing was not considered a good option for Logan, given his age and the degree of his spinal curve. Instead, Dr. Sturm explained that at this stage, the most commonly performed procedure would be a spinal fusion surgery, which would permanently connect up to 10 or more vertebrae (bones in the spine) to correct the curve.

“The idea of losing spinal mobility at the age of 16 and dealing with the lifelong implications of a fused spine was heartbreaking,” Amy said. Logan and his parents asked if there were other surgical options available. Dr. Sturm explained the U.S. Food and Drug Administration had approved a procedure recently that Logan may qualify for and referred Logan to pediatric spine surgeon Viral Jain, MD, for possible vertebral body tethering (VBT) surgery.

VBT is a treatment option for certain scoliosis patients who are still growing, where a strong cord called a tether is attached to the spine to correct the curve. Logan learned that although it was still a major surgery, the recovery time after VBT is significantly less compared to spinal fusion, and for a junior in high school, who had the goal of being ready for tennis tryouts in early March, this was a major factor in his decision.

"I passed out at every doctor's appointment. I don't remember much," said Logan with a laugh.

Logan explained that with spinal fusion, he wouldn’t be able to twist as much for golf and tennis. With VBT, though, his spine would not be fused together, allowing for more movement. Logan also emphasized that although it is fun to miss class sometimes, missing significant class time during his junior year of high school would have had a huge impact on his grades.

He and his parents knew that doing nothing was not an option, however, and when comparing both surgeries, VBT was Logan’s definite preference.

“We were very nervous about choosing to move forward with such a newly FDA approved procedure, but Dr. Jain and his nursing staff did an amazing job answering all of our questions allowing us to feel more confident in our decision,” said Logan’s dad, Matt.

The successful VBT surgery took place in October 2022 at Cincinnati Children’s. Logan was discharged and returned home after only three days in the hospital and returned to a partial school day only 12 days post-surgery compared to estimates of 1-2 months off school for the spinal fusion surgery.

According to Dr. Jain, the timing of the surgery was important. It offered Logan’s young body the necessary time to grow and allowed the tethering correction to take effect. A delay in the surgery might have prevented Logan from being a viable candidate.

The overall success rate of VBT surgery, which gained FDA approval in 2019, has improved over time and the risk of re-operation has reduced across North America, said Dr. Jain. 

“This is mainly related to improved knowledge of the technique and knowledge of curve behavior,” he said. “At Cincinnati Children’s, we only offer this procedure to patients who are ideal candidates for it, where we predict risk of re-operation is low.” 

Spinal Curve Decreases Over Time, Physical Therapy Helps Logan Return to Tennis Court

Logan’s spinal curve improved to 21 degrees coming out of surgery, then six months later was measured at 17 degrees and 15 degrees later in the year. Any additional improvement will be directly related to how much Logan grows in the coming years.

“It’s possible his curve will improve, but he already has great correction,” said Dr. Jain. 

While the surgery was a success, months of demanding physical therapy was the necessary next step for Logan as he regained his strength and returned to his ideal athletic performance. 

According to Logan’s physical therapist, Matt Kanetzke, PT, both spinal fusion and VBT patients have minimal restrictions for daily activities immediately following surgery, and Logan was no different. 

“This is because the anchoring is done into the vertebral bone in both cases. [These surgeries] allow us to continue to appropriately and gradually stress the muscles and joints in the surrounding area with respect to the amount of force we are pulling on the vertebral bones involved in surgery,” he said. 

Where Logan differed from spinal fusion patients, said Kanetzke, was the amount of motion he showed at the initial evaluation, and the speed at which he regained motion, muscle strength and motor control.

“This [success] was in large part based on his dedication to his home exercise program, but also likely contributed to the type of surgery performed, as it allows maintenance of flexibility and continued growth,” said Kanetzke, who focused PT exercises on strengthening and stabilizing Logan’s core muscles. 

A customized, return to play program was catered to Logan’s tennis goals. Last spring, after nearly four months of intense physical therapy, he was able to return to the tennis court, where he competed on his school’s junior varsity team. 

“Although he had a slow start to the season as he worked to regain his strength, confidence, and endurance, seeing Logan back on the court doing what he loves so soon after having major spine surgery was truly remarkable” said Amy. “It reassured us that we made the right decision.”

Amy admits she was a bit nervous to see the X-rays at Logan's most recent appointment in August. 

"I mean, how could his tether be holding with as much activity as this kid does?” asked Amy. “It's just hard to believe that he had his spine ‘rebuilt’, and now he's wakeboarding and playing tennis and golf—like nothing ever happened. But everything was stable and perfect." 

Logan feels better than ever with spring tennis season soon approaching.

"I'm definitely standing up straighter. And I feel way more flexible than I was before,” he said. “I’m picking up speed in both golf and tennis. I feel great.”  

(Published November 2023)