Insurer Denies Cutting-Edge Scoliosis Surgery for 12‑Year‑Old — Family Sues to Force Coverage

Family Sues After Aetna Refuses To Cover Vertebral Body Tethering

Anne Marie Hukriede of Centennial, Colorado, has appealed three times after Aetna denied coverage for her 12-year-old daughter Vivian’s recommended vertebral body tethering (VBT) surgery. The insurer’s most recent denial came on Nov. 11, just days before the planned operation, forcing the family to postpone treatment because out-of-pocket costs could approach $100,000.

What Is VBT?

Vertebral body tethering (VBT) is a growth-modulation procedure designed for growing children with progressive scoliosis. Surgeons attach a flexible cord, or "tether" (manufactured by Highridge), to vertebrae on the convex side of the curve. As the child grows, the tether slows growth on that side and permits relative growth on the opposite side, gradually straightening the spine while preserving more range of motion than a traditional fusion.

Regulatory, Clinical And Insurance Positions

The Food and Drug Administration approved the Highridge tether in 2019, concluding that "the probable benefits outweigh the probable risks" for children with worsening scoliosis. Major specialty groups — including the Scoliosis Research Society and the Pediatric Orthopedic Society of North America — recommend insurers cover VBT for appropriate pediatric candidates.

Despite that, Aetna and several other insurers continue to classify the procedure as experimental. Aetna said an internal panel concluded VBT is "outside the standard of care for a 12 year-old child presenting with scoliosis," and that available data show higher complication rates and inferior outcomes versus standard posterior spinal fusion.

Fusion Versus Tethering: Tradeoffs

The standard posterior spinal fusion uses rods and screws to straighten and fuse the spine; it is durable but can limit spinal motion and may accelerate degeneration of adjacent discs. Advocates of VBT argue it preserves motion and reduces long-term disc injury, though VBT carries its own risks: because the tether is flexible it can break, and surgeons estimate roughly 20% of patients will require a later fusion or a revision surgery.

Evidence And Expert Views

The FDA’s approval relied on a trial of 57 patients: after two years, 43 showed sufficient curvature improvement. A smaller five-year study of 29 early patients reported a 64% success rate — lower than typical fusion success rates — but clinicians say outcomes have likely improved as selection criteria and surgical techniques advanced. A follow-up study co-authored by a key researcher reported no major post-operative complications, though some patients later required additional procedures.

Surgeons who perform VBT pushed back on Aetna’s characterization of the technique. "When I see somebody who truly is an indicated, ideal candidate for the procedure and I cannot provide that, that’s a sad day," said Dr. Daniel Hoernschemeyer, a pediatric orthopedic specialist. The article notes conflicts of interest where present: Hoernschemeyer is a paid speaker for Highridge and serves on its medical education team; Dr. Amer Samdani — whose research contributed to FDA approval — receives royalties and consulting fees related to the device.

Patient Impact And Legal Response

For Vivian, whose spinal curve resembles a question mark, scoliosis causes pain while sitting in class and interferes with dance, her favorite activity. Because the tether works best while a child still has substantial growth remaining (peak growth for girls typically occurs between ages 10 and 14), the family says the window for optimal treatment is narrowing.

After exhausting internal appeals, the Hukriedes sued Aetna in Colorado district court this week, asking a judge to compel the insurer to reverse its denial and allow Vivian to proceed with the recommended operation.

"It’s disheartening, frustrating. You get angry. We pay a lot of money in insurance premiums to have things covered," Hukriede said.

Broader Context

Surgeons say denials like Aetna’s reflect a broader pattern of insurers being conservative about new devices and procedures until more long-term data accumulate. Physicians report spending substantial time appealing coverage denials. The disputes come amid a national debate over health care affordability; a May KFF survey found about 42% of U.S. adults say it’s difficult to afford care even with insurance.

Note: This article summarizes reporting on clinical evidence, regulatory decisions, expert views and a pending lawsuit. Readers should consult treating physicians and insurers for individualized guidance.