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. 2010 Jan 15;35(2):169-76.
doi: 10.1097/BRS.0b013e3181c6dff5.

Vertebral body stapling: a fusionless treatment option for a growing child with moderate idiopathic scoliosis

Randal R Betz  1 , Ashish Ranade, Amer F Samdani, Ross Chafetz, Linda P D'Andrea, John P Gaughan, Jahangir Asghar, Harsh Grewal, Mary Jane Mulcahey
Affiliations

Vertebral body stapling: a fusionless treatment option for a growing child with moderate idiopathic scoliosis

Randal R Betz et al. Spine (Phila Pa 1976). .

Abstract

Study design: Retrospective review.

Objective: To report the results of vertebral body stapling (VBS) with minimum 2-year follow-up in patients with idiopathic scoliosis.

Summary of background data: While bracing for idiopathic scoliosis is moderately successful, its efficacy has been called into question, and it carries associated psychosocial ramifications. VBS has been shown to be a safe, feasible alternative to bracing for idiopathic scoliosis.

Methods: We retrospectively reviewed 28 of 29 patients (96%) with idiopathic scoliosis treated with VBS followed for a minimum of 2 years.

Inclusion criteria: Risser sign of 0 or 1 and coronal curve measuring between 20 degrees and 45 degrees .

Results: There were 26 thoracic and 15 lumbar curves. Average follow-up was 3.2 years. The procedure was considered a success if curves corrected to within 10 degrees of preoperative measurement or decreased >10 degrees . Thoracic curves measuring <35 degrees had a success rate of 77.7%. Curves which reached < or =20 degrees on first erect radiograph had a success rate of 85.7%. Flexible curves >50% correction on bend film had a success rate of 71.4%. Of the 26 curves, 4 (15%) showed correction >10 degrees. Kyphosis improved in 7 patients with preoperative hypokyphosis (<10 degrees of kyphosis T5-T12). Of the patients, 83.5% had remaining normal thoracic kyphosis of 10 degrees to 40 degrees. Lumbar curves demonstrated a success rate of 86.7%. Four of the 15 lumbar curves (27%) showed correction >10 degrees. Major complications include rupture of a unrecognized congenital diaphragmatic hernia and curve overcorrection in 1 patient. Two minor complications included superior mesenteric artery syndrome and atelectasis due to a mucous plug. There were no instances of staple dislodgement or neurovascular injury.

Conclusion: Analysis of patients with idiopathic scoliosis (IS) with high-risk progression treated with vertebral body stapling (VBS) and minimum 2-year follow-up shows a success rate of 87% in all lumbar curves and in 79% of thoracic curves <35 degrees. Thoracic curves >35 degrees were not successful and require alternative treatments.

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