Vertebral Body Stapling for Moderate Juvenile and Early Adolescent Idiopathic Scoliosis: Cautions and Patient Selection Criteria. Issue 24 (December 2015)

• Record Type: Journal Article
• Authors: Bumpass, David B.; Fuhrhop, Sara K.; Schootman, Mario; Smith, June C.; Luhmann, Scott J.
• Is Part Of: Spine. Volume 40:Issue 24(2015)
• Publication Date: 2015-12
• Subjects: adolescent idiopathic scoliosis -- bracing -- fusionless scoliosis surgery -- juvenile idiopathic scoliosis -- vertebral body stapling; Spine -- Abnormalities -- Periodicals; Spine -- Diseases -- Periodicals; Spine -- Surgery -- Periodicals; 616.73005
• DOI: 10.1097/BRS.0000000000001135
• Languages: English
• ISSNs: 0362-2436

Abstract

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. Level of Evidence: 4