An innovative technique of vertebral body stapling for the treatment of patients with adolescent idiopathic scoliosis: a feasibility, safety, and utility study.
METHODS
Retrospective review.


OBJECTIVE
To report the feasibility, safety, and utility of vertebral body stapling without fusion as an alternative treatment for adolescent idiopathic scoliosis.


BACKGROUND
The success rate of brace treatment of adolescent idiopathic scoliosis ranges from 50% to 82%. However, poor self-image and brace compliance are issues for the patient. An alternative method of treatment such as a motion-preserving vertebral body stapling to provide curve stability would be desirable.


METHODS
We retrospectively reviewed 21 patients (27 curves) with adolescent idiopathic scoliosis treated with vertebral body stapling. Patients were immature as defined by Risser sign <or=2.


RESULTS
The concept of vertebral body stapling of the convex side of a patient with adolescent idiopathic scoliosis is feasible. The procedure was safe, with no major complications and three minor complications. One patient had an intraoperative segmental vein bleed resulting in an increased estimated blood loss of 1500 cc as compared to the average estimated blood loss of 247 cc for all patients. One patient had a chylothorax and one pancreatitis. No patient has had a staple dislodge or move during the follow-up period (mean 11 months, range 3-36 months), and no adverse effects specifically from the staples have been identified. Utility (defined as curve stability) was evaluated in 10 patients with stapling with greater than 1-year follow-up (mean 22.6 months) and preoperative curve <50 degrees. Progression of >or=6 degrees or beyond 50 degrees was considered a failure of treatment. Of these 10 patients, 6 (60%) remained stable or improved and 4 (40%) progressed. One of 10 (10%) in the stapling group had progressed beyond 50 degrees and went on to fusion. Six patients required stapling of a second curve, three as part of the primary surgery, and three as a second stage, because a second untreated curve progressed. The results need to be considered with caution, as the follow-up is still short.


CONCLUSIONS
The data demonstrate that vertebral body stapling for the treatment of scoliosis in the adolescent was feasible and safe in this group of 21 patients. In the short-term, stapling appears to have utility in stabilizing curves of progressive adolescent idiopathic scoliosis.
Betz
Randal R
RR
Shriners Hospitals for Children, Philadelphia, PA 19140, USA. rbetz@shrinenet.org
Kim
John
J
D'Andrea
Linda P
LP
Mulcahey
M J
MJ
Balsara
Rohinton K
RK
Clements
David H
DH
D000293:Adolescent; D000497:Alloys; D002648:Child; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D019637:Orthopedic Procedures / Q000295:instrumentation / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012600:Scoliosis / Q000473:pathology / Q000601:surgery*; D013131:Spine / Q000601:surgery*; D016896:Treatment Outcome
D000497:Alloys; C013616:nitinol