Insurance Challenges Delay FDA-Approved Scoliosis Surgery Coverage

Vertebral body tethering (VBT) is a spinal surgery procedure approved by the FDA in 2019 as a treatment for children with worsening scoliosis, designed to correct spine curvature by using a flexible tether that guides spinal growth. Despite FDA approval and recommendations from professional orthopedic societies, some U.S. insurance companies, including Aetna, classify the surgery as experimental and deny coverage, citing concerns over long-term safety, efficacy, and complication rates compared to standard spinal fusion. Spinal fusion, the conventional surgical method, stabilizes the spine with rods and screws but can limit motion and potentially cause disc degeneration, whereas VBT aims to preserve spinal mobility and reduce these risks. Surgeons performing VBT argue that the procedure's benefits and patient selection criteria have become clearer with growing clinical experience and published outcomes, challenging insurers' reluctance to update coverage policies to reflect current medical research. Denials of VBT coverage lead to delayed or canceled surgeries for patients, compromising treatment timing during critical growth periods for scoliosis patients, often adolescents, which may affect surgical effectiveness. The cost of VBT, potentially reaching $100,000, places significant financial strain on families when insurance coverage is denied, as illustrated by the Hukriede family's ongoing legal dispute against Aetna in Colorado. Clinical studies indicate that while some patients require additional surgery due to risks like tether breakage or curve overcorrection, the procedure has demonstrated sufficient improvement in most cases, and surgeons emphasize that VBT offers an alternative that may mitigate long-term complications relative to spinal fusion. Insurance disputes over VBT coverage exemplify broader challenges in the U.S. healthcare system related to insurer adoption of new medical technologies and the impact of coverage gaps on patient access to innovative treatments. Industry experts suggest enhanced insurer alignment with evolving clinical evidence and clearer coding and reimbursement pathways could increase access to VBT. This case highlights ongoing tensions between evidence-based medical advancements and insurance coverage policies, underscoring the need for timely incorporation of emerging treatments within payer frameworks to optimize patient outcomes in scoliosis care. The debate surrounding VBT insurance coverage also reflects wider concerns about healthcare affordability and access to specialty treatments among U.S. pediatric populations with complex orthopedic needs.