VBT at @CHI_Ireland is a clear example of why governance and oversight in children’s spinal surgery matter. • Vertebral Body Tethering (VBT) is a non-fusion scoliosis surgery using screws and a flexible tether to correct the spine while preserving growth and movement. • CHI itself described VBT as an “experimental technology”. • CHI identified no research papers relating to VBT conducted at CHI. • At least 10 VBT procedures were performed. • VBT surgery was facilitated through Straight Ahead, a @CHI_Ireland charity, raising questions about the governance and funding pathway through which an experimental procedure was provided. • VBT had not been discussed at CHI’s Ethics Committee. • There were no minutes of the weekly clinical indications meetings. • CHI held no records relating to adverse events or internal reviews of VBT outcomes. • There was no VBT-specific patient information leaflet or consent form. • There was no specific procedure code for VBT. It was coded as a spinal fusion, despite VBT specifically being a non-fusion procedure. • There was no spine register to separately track these children and their outcomes. • No records were identified of strategic planning, meeting minutes or Board-level discussions on the future use or evaluation of VBT. • In April 2025, Clinical Lead David Moore was asked Parliamentary Questions about these very issues, including regulation, coding, audit and how VBT outcomes were being tracked. He did not substantively answer them and described the questions as “sudden and ambiguous”. • These issues do not appear to have been identified or examined in the published @HIQA report into paediatric spinal surgery. We now also know that uncertified spinal springs were implanted in children at CHI. These are not unrelated governance questions. They show why proper medical-device oversight, coding, registers, documentation, audit and independent scrutiny matter. When those safeguards are missing or inadequate, how do you know what is happening to children? 🚩 And how did the HIQA report not identify this? @CarrollJennifer @AnneOConnorIRL @npsoIRL @CHI_Ireland

CHI completed 251 spinal procedures by the end of June 2025. By the end of June 2026, that had fallen to 237. That’s a 5.6% reduction, despite additional resources, outsourcing and the Cappagh programme. Families have been forced to seek surgery outside @CHI_Ireland because they could not wait. @AnneOConnorIRL @CcoHse Why has surgical activity gone backwards? @CarrollJennifer