Anterior Vertebral Body Stapling for the Treatment of Idiopathic Scoliosis

Abstract

The standard of care for moderate idiopathic scoliosis (20°–45°) typically involves observation and bracing to prevent further curve progression. However, several studies suggest that bracing is only effective when worn >12 h a day and may create psychosocial stresses resulting in limited compliance (Rahman et al., J Pediatr Orthop 25(4):420–422, 2005; Katz et al., J Bone Joint Surg Am 92(6):1343–1352, 2010; Helfenstein et al., Spine (Phila Pa 1976) 31(3):339–344, 2006; Weinstein et al., N Engl J Med 369(16):1512–1521, 2013; Misterska et al., Spine (Phila Pa 1976) 37(14):1218–1223, 2012; Cheung et al., Int Orthop 31:507–511, 2007; Misterska et al., Med Sci Monit 17(2):CR83–CR90, 2011). Furthermore, in patients with juvenile idiopathic scoliosis with curves between 20° and 30° at the onset of puberty, it has been shown that there is a 75% risk of requiring a spinal fusion, and in curves >30°, there is a 100% risk of fusion (Dimeglio et al., J Pediatr Orthop 31(1 Suppl):S28-S36, 2011). In a subset of skeletally immature patients with progressive idiopathic scoliosis and significant growth remaining, surgical spinal growth modulation is an alternative to bracing for the treatment of moderate idiopathic scoliosis. Spinal growth modulation relies upon the Hueter-Volkmann principle to slow growth on the convexity of the curve and allow growth on the concavity of the curve, resulting in gradual correction of the deformity. Several devices are currently utilized including vertebral body stapling (VBS) and vertebral body tethering (VBT). The potential advantages of these techniques are curve correction through a minimally invasive thoracoscopic or a mini-open retroperitoneal approach, a quicker recovery, and preservation of motion.