Vertebral body stapling: a fusionless treatment option for a growing child with moderate idiopathic scoliosis.
METHODS
Retrospective review.


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


BACKGROUND
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.


METHODS
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.


CONCLUSIONS
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.
Betz
Randal R
RR
Shriners Hospitals for Children, Philadelphia, PA, USA. rbetz@shrinenet.org
Ranade
Ashish
A
Samdani
Amer F
AF
Chafetz
Ross
R
D'Andrea
Linda P
LP
Gaughan
John P
JP
Asghar
Jahangir
J
Grewal
Harsh
H
Mulcahey
Mary Jane
MJ
D000293:Adolescent; D001858:Bone Nails; D002648:Child; D002675:Child, Preschool; D020878:Device Removal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007738:Kyphosis / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D019637:Orthopedic Procedures / Q000295:instrumentation*; D012189:Retrospective Studies; D012600:Scoliosis / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000601:surgery*; D016896:Treatment Outcome