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Anterior vertebral body tethering (AVBT) is a surgical technique utilized primarily to address adolescent idiopathic scoliosis (AIS) in growing children and adolescents. The procedure aims to correct spinal deformities while allowing for continued growth of the spine, thereby minimizing the risk of over-correction and subsequent rigid spinal alignment. AVBT differs from traditional fusion surgeries, where the vertebrae are permanently joined, inhibiting growth and flexibility. Instead, AVBT employs a flexible tether made of bio-compatible materials, such as polyethylene or similar polymers, which is surgically attached to the anterior aspect of the vertebral bodies. This tether effectively spans the curve in the spine, creating a system that guides growth patterns by restricting anterior vertebral growth on the convex side of the spine while allowing continued growth on the concave side. As the child grows, the differential growth encouraged by the tether can lead to gradual curvature correction without limiting overall spinal development. The main benefits of this technique include the preservation of spinal mobility and the potential for minimal scarring since it can often be performed using minimally invasive surgical techniques. Furthermore, AVBT can reduce complications commonly associated with traditional fusion surgeries, such as adjacent segment degeneration and loss of flexibility. Post-operative care typically includes braces or physical therapy to promote optimal recovery and function. Initial studies and clinical outcomes have indicated promising results, showing significant curvature reduction and improved overall spinal alignment in many patients. Nevertheless, AVBT is not suitable for all types of scoliosis, and careful patient selection is critical for optimal outcomes. Considerations such as the severity and type of curvature, patient's skeletal maturity, and overall health status play significant roles in determining eligibility for the procedure. The long-term effectiveness of AVBT is still being investigated, with ongoing research focused on understanding the best practices, potential complications, and outcomes over time. As the technique continues to evolve, there is a growing interest among orthopedic surgeons and spinal specialists in its application, and advancements in surgical technology and materials will likely contribute to its refinement. Overall, anterior vertebral body tethering represents an evolving approach in spinal surgery, providing an innovative alternative for pediatric patients with scoliosis, aiming to achieve a balance between deformity correction and the preservation of spinal development. This method reflects a broader trend in orthopedics toward less invasive interventions and preservation-focused treatments, emphasizing individualized patient care and optimizing functional outcomes in growing children. As knowledge and experience with AVBT expand, it may become a cornerstone in the management of scoliosis in young patients, ultimately enhancing their quality of life and development trajectory.