Thoracoscopic Vertebral Body Stapling for Treatment of Scoliosis in Young Children

Abstract

The management of juvenile idiopathic scoliosis (JIS) in young children can be challenging. Vertebral body stapling (VBS) is a new alternate to bracing and is intended to reduce or eliminate the need for subsequent spinal fusion. In concept, VBS of the anterior spine inhibits curve progression, thus stabilizing the spine as the child grows. There is a paucity of data in the pediatric population on its effectiveness. Therefore, we reviewed our experience with thoracoscopic VBS in children with juvenile scoliosis. After Institutional Review Board approval was obtained, a retrospective study was conducted on all patients who underwent thoracoscopic VBS for scoliosis from January 2007 to December 2010. Only patients with a follow-up of at least 2 years were included in this study group. Data obtained were demographics, indications for VBS, degree of curvature, treatment, complications, and follow-up. Cobb angle was used to measure the initial degree of curvature on a standing posterior-anterior spine radiograph. During the study period, 11 patients underwent thoracoscopic VBS for JIS using single lung ventilation in a lateral position. Of those, 7 patients ages 8-11 years (mean, 9 years) with a mean body mass index of 17 kg/m(2) (±2.9 kg/m(2)) had at least a 2-year follow-up and make up the study group for this review. Indications for stapling in these 7 patients were progression of scoliosis (n=3), noncompliance with brace (n=3), and double curve with progression (n=1). The mean preoperative Cobb angle was 34.1±5° (range, 25°-41°), and the mean immediate postoperative Cobb angle was 23±5° (range, 16°-30°). The staples encompassed a mean number of 6.4 vertebral bodies. The mean duration of chest drainage was 2.7 days (range, 2-6 days), and the mean length of hospitalization was 3.9 days (range, 3-7 days). The mean operative time was 156.2±39.5 minutes (range, 101-214 minutes). There were no intraoperative complications or mortality. Postoperatively, 1 patient developed a pleural effusion on the contralateral side that required drainage. These 7 patients have been followed up for a mean of 34 months (range, 29-44 months). The mean Cobb angle at last follow-up was 24.7° (range, 15-38°). No patient has required postoperative bracing or spinal fusion. Thoracoscopic VBS is a safe and effective method of treatment for progressive scoliosis in young children. Pediatric surgeons may be asked to assist their spine surgeons with this new approach to juvenile scoliosis.