Vertebral Body Stapling for Moderate Juvenile and Early Adolescent Idiopathic Scoliosis: Cautions and Patient Selection Criteria

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Abstract

Study Design.

Single-surgeon retrospective case series.

Objective.

To validate and further describe clinical and radiographic outcomes of patients undergoing vertebral body stapling (VBS), with the goal of learning if VBS is a safe and effective alternative to bracing for treating moderate idiopathic scoliosis (IS) in the growing pediatric patient.

Summary of Background Data.

VBS is a growth-modulation technique to control moderate idiopathic scoliosis (IS) while avoiding fusion. Existing studies state successful curve control rates equivalent to bracing, but the majority of reports have come from a single institution.

Methods.

All IS patients who underwent VBS by 1 surgeon were included. Indications were brace intolerance and a structural coronal curve of 25° to 40°. Proportional nitinol staples were used in all cases. Pre- and postoperative radiographs, pulmonary function testing, and physical exam measurements were serially recorded.

Results.

VBS was performed on 35 patients (28 females, 7 males) with mean age 10.5 years (range 7.0–14.6 years). Total of 31 patients (33 stapled curves) completed follow-up. Preoperative Risser grade was 0 in 31 patients, 1 in 1 patient, and 2 in 3 patients. Stapled curves were controlled with <10° of progression in 61% of cases. Curves <35° had a control rate of 75%, and patients <10 years had a 62% curve control rate. Eleven patients (31%) required subsequent fusions; two curves (6%) over-corrected. Preoperative supine flexibility > 30% was predictive of ultimate curve control. No neurologic complications were encountered; 5 patients (14%) developed small pneumothoraces.

Conclusion.

This series contains the most patients and longest followup reported for VBS. Successful curve control was achieved less frequently than in previous reports, particularly in patients <10 years.

Conclusion.

Level of Evidence: 4

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