Vertebral Body Stapling versus Bracing for Patients with High-Risk Moderate Idiopathic Scoliosis

Abstract

Purpose. We report a comparison study of vertebral body stapling (VBS) versus a matched bracing cohort for immature patients with moderate (25 to 44°) idiopathic scoliosis (IS). Methods. 42 of 49 consecutive patients (86%) with IS were treated with VBS and followed for a minimum of 2 years. They were compared to 121 braced patients meeting identical inclusion criteria. 52 patients (66 curves) were matched according to age at start of treatment (10.6 years versus 11.1 years, resp. [P = 0.07]) and gender. Results. For thoracic curves 25–34°, VBS had a success rate (defined as curve progression <10°) of 81% versus 61% for bracing (P = 0.16). In thoracic curves 35–44°, VBS and bracing both had a poor success rate. For lumbar curves, success rates were similar in both groups for curves measuring 25–34°. Conclusion. In this comparison of two cohorts of patients with high-risk (Risser 0-1) moderate IS (25–44°), in smaller thoracic curves (25–34°) VBS provided better results as a clinical trend as compared to bracing. VBS was found not to be effective for thoracic curves ≥35°. For lumbar curves measuring 25–34°, results appear to be similar for both VBS and bracing, at 80% success.

Evaluation and management of adolescent idiopathic scoliosis: a review

“…However, the indications for vertebral body stapling were quite narrow, encompassing curves ideally between 25° and 34° in magnitude. 8 Ultimately, research based on the staple led to further advances, and current investigations into a vertebral body tether are ongoing. 48 Currently, the most commonly adopted surgical approach is posterior spinal fusion with or without multiple Ponte osteotomies with derotation techniques to provide correction.…”

Surgical Treatment of Pediatric Scoliosis: Historical Origins and Review of Current Techniques

“…Results equivalent to bracing have been reported when VBS is used to treat small curves in adolescent idiopathic scoliosis. When comparing vertebral body stapling and bracing in adolescents with Risser scores ≤ 1, Cuddihy et al found an equivalent reduction of 25–34° in the curve progression of the thoracic curves and of 25–34° in that of the lumbar curves between bracing and VBS [ 82 ]. Unfortunately, these results have not translated to larger curves.…”

“…O’Leary et al found that in 11 adolescents with severe non-idiopathic curves (average 68°), 73% ( n = 8) of patients required or were considering a second operation at the 2 month follow-up [ 83 ]. Thus, VBS is a poor choice for curves >35° but may be an alternative to bracing for children who cannot tolerate such external immobilization [ 82 ].…”

Concave and convex growth do not differ over tethered vertebral segments, even with open tri-radiate cartilage

“…In 2010, Crawford and Lenke reported the first case successfully managed with VBT in an 8-year old [6]. Since then, multiple case series and clinical trials have been published with encouraging results [7][8][9][10][11][12][13]. It is thought to rely on the asymmetric inhibition of vertebral growth by applying the Hueter-Volkmann principle: growth plate compression slows vertebral growth while growth plate distraction promotes vertebral growth [14][15][16][17][18][19].…”