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Treatment of Idiopathic Scoliosis With Vertebral Body Stapling

  • Case Report
  • Published:
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Abstract

Study Design

Retrospective cohort.

Objectives

Identify the effectiveness of vertebral body stapling (VBS) in children with idiopathic scoliosis.

Summary of Background Data

VBS has been proposed as an alternative to bracing moderate curves in patients with adolescent idiopathic scoliosis (AIS) although a clear picture of comparative efficacy and safety remains to be established.

Methods

Ten skeletally immature patients with AIS and curves between 25° and 35° underwent anterior VBS by a single surgeon from 2008 to 2018. Indications included strong family history, high ScoliScore, curve progression despite bracing, or as an alternative for patients/families refusing bracing. Patients with thoracic kyphosis greater than 40°, curvature with a level above T4 or below L4, and double major curves were contraindicated. Patients with hybrid surgical plans or those who failed to reach skeletal maturity were excluded. Age, gender, levels stapled, pre- and postoperative radiographs, and incidence of secondary surgical intervention were evaluated. Outcomes were also compared with untreated and braced subjects from the BrAIST study.

Results

Ten patients met the inclusion criteria. Average age at VBS was 11.8 (9.7–13.5) with an average major Cobb angle of 30.9° (26°–35°). Average duration of follow-up was 6.4 years. All patients demonstrated curve correction at their first postoperative visit. At final follow-up, 50% of patients experienced curve progression greater than 5°, whereas the remaining 50% either remained stable or corrected over time. The five patients whose curves progressed underwent VBS at a significantly younger age (10.8 vs. 12.8; p value .003). Four of these patients required additional surgical intervention for worsening scoliosis.

Conclusions

Although early outcomes after VBS appear to parallel the results of bracing, stapling does not affect the percentage of patients ultimately requiring PSIF. Initial curve correction degraded over time in younger patients with significant growth remaining, and high rates of progression in this group, even with bracing, merits investigation into more efficacious treatment strategies.

Level of Evidence

Level III.

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Author information

Authors and Affiliations

  1. Morgan Stanley Children’s Hospital of New York-Presbyterian, Columbia University Medical Center, 370 Fort Washington Ave, Apt 306, 3959 Broadway, 10032, New York, NY, USA

    Evan Trupia MD, Anny C. Hsu MS, MD, Hiroko Matsumoto MS, PhD & Michael Vitale MD, PhD

  2. Columbia University Medical Center, CH-8N, 3959 Broadway, 10032, New York, NY, USA

    John D. Mueller BS

  3. Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, 10029, New York, NY, USA

    Lawrence Bodenstein MD, PhD

Authors
  1. Evan Trupia MD
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  2. Anny C. Hsu MS, MD
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  3. John D. Mueller BS
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  4. Hiroko Matsumoto MS, PhD
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  5. Lawrence Bodenstein MD, PhD
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  6. Michael Vitale MD, PhD
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Corresponding author

Correspondence to Evan Trupia MD.

Additional information

Author disclosures: ET (none), ACH (none), JDM (none), HM (grants from Pediatric Orthopaedic Society of North America [POSNA] and Scoliosis Research Society; personal fees from Children’s Spine Foundation, other from American Academy for Cerebral Palsy and Developmental Medicine [AACPDM], outside the submitted work), LB (none), MV (grants from POSNA, during the conduct of the study; other from POSNA, Biomet, and Wellinks; personal fees from Stryker, Biomet, and Medtronic, outside the submitted work).

IRB approval: IRB-AAAO8862. This work is approved by the Institutional Review Board (IRB) of Columbia University.

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Trupia, E., Hsu, A.C., Mueller, J.D. et al. Treatment of Idiopathic Scoliosis With Vertebral Body Stapling. Spine Deform 7, 720–728 (2019). https://doi.org/10.1016/j.jspd.2019.01.006

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