Vertebral Body Stapling Research Articles

Innovative technologies in thoracolumbar and lumbar spine surgery failing to reach standard of care: state-of-art review.

To evaluate previously popular technologies in the field of spine surgery, and to better understand their advantages and limitations to the current standards of care. Spine surgery is an ever-evolving field that serves to resolve various spinal pathologies in patients of all ages. While there are established treatments for various conditions, such as lumbar spinal stenosis, idiopathic scoliosis, and degenerative lumbar disease, there is always further research and development in these areas to produce innovative technologies that can lead to better outcomes. As this process progresses, we must remind ourselves of previously tried and tested inventions and their outcomes that have fallen short of becoming a standard to ensure we are able to learn lessons from the past. A thorough literature review was conducted with the aim of compiling literature of previously utilized technologies in spine surgery. Biomedical databases were utilized to gather relevant articles including PubMed, MEDLINE, and EMBASE. Emphasis was placed on gathering articles with technologies or therapeutics aimed at treating common spinal pathologies including lumbar spinal stenosis (LSS), adolescent idiopathic scoliosis (AIS), and other degenerative lumbar spine diseases. The keywords used were: "failed technologies", "historical technologies", "spine surgery", "spinal stenosis", "adolescent idiopathic scoliosis", and "degenerative lumbar spine disease". A total of 47 articles were gathered after initial review. Different technologies pertaining to spine surgery were identified and critically evaluated. Some of these technologies included X-STOP, Vertiflex, Vertebral Body Stapling, and Dynesys. These technologies were evaluated for their strengths and limitations across their spinal pathology applications. While each type of technology had their benefits, the data tended to be mixed with various limitations across studies. These technologies have been trialed in the field of spine surgery across various spinal pathologies, but still prove of limited efficacy and shortcomings to the current standards of care.

Role of growth modulation in the management of idiopathic scoliosis: A narrative review of literature

Scoliosis is a condition in which there is a lateral curve to the spine. The cause of scoliosis is unknown, but different aetiologies have been suggested, but mostly cause has been idiopathic in nature. Muscle spasms, cerebral palsy, Marfan syndrome, and tumours (neurofibromatosis) are some of the suggested aetiologies. Progressive adolescent idiopathic scoliosis (AIS) affects mainly girls and anterior spinal overgrowth during the second growth spurt appear to be a significant cause. The diagnosis of scoliosis is primarily a clinical suspicion followed by an AP and lateral X ray of spine in standing position. Measurement of the Cobb angle is the standard method of assessing the curvature in a quantitative manner. It is the angle between two lines, drawn perpendicular to the upper endplate of the first vertebra involved and the lower endplate of the last vertebra involved. Cobb angles are followed for both curves for those with two curves. Risser classification grades the skeletal maturity on X rays and is considered along with the Cobb angle to making a decision towards surgery. Indications for surgical correction of scoliosis is not clearly defined however, the treatment of scoliosis is based on the severity and progressive nature of the curve. Cobb angle above 40 degrees, rapidly progressing curve, major thoracic deformity affecting the function such as breathing and cosmetic reasons, are some of the indications for surgery. There are several modalities of surgical correction. Main method has been correction of the deformity and fixation with one or two rods and pedicle screws followed by bone grafting. Harrington rods were the primarily used system, but with time many spinal instrumentation systems and rods have been introduced to the market. Apart from using rods some have tried anterior vertebral body stapling and anterior vertebral body tethering for correction scoliosis using the principle of growth modulation.
 We conducted a systematic review to answer the question, 'What is the role of growth modulation in the management of idiopathic scoliosis?' All articles / publications published from 2010 May to 2019 October were used as research data. A health, related database (PubMed) was used for the search. Search criteria revealed 99 articles initially and 37 articles after filtered based on title reading. Then 18 articles were selected for the final analysis after being filtered manually by reading summary and abstracts of each article.

The effect of vertebral body stapling on spine biomechanics and structure using a bovine model

BackgroundAdolescent idiopathic scoliosis is a common condition affecting 2.5% of the general population. Vertebral body stapling was introduced as a method of fusionless growth modulation for the correction of moderate idiopathic scoliosis (Cobb angles of 20–40°), and was claimed to be more effective than bracing and less invasive than fusion.The aim of this study was to assess the effect of vertebral body stapling on the stiffness of a thoracic motion segment unit under moment controlled load, and to assess the vertebral structural damage caused by the staples. MethodsThoracic spine motion segments from 6 to 8 week old calves (n=14) were tested in flexion/extension, lateral bending, and axial rotation. The segments were tested un-instrumented, then a left anterolateral intervertebral Shape Memory Alloy (SMA) staple was inserted and the test was repeated. Data were collected from the tenth load cycle of each sequence and stiffness was calculated. The staples were carefully removed and the segments were studied with micro-computed tomography to assess physical damage to the bony structure. Visual assessment of the vertebral bone structure on micro-CT was performed. FindingsThere was no change in motion segment stiffness in flexion/extension nor in axial rotation. There was a reduction in stiffness in lateral bending with 30% reduction bending away from the staple and 12% reduction bending towards the staple. Micro-CT showed physeal damage in all the specimens. InterpretationIntervertebral stapling using SMA staples cause a reduction in spine stiffness in lateral bending. They also cause damage to the endplate epiphyses.

Continued vertebral body growth in patients with juvenile idiopathic scoliosis following vertebral body stapling.

Retrospective case series. To quantitatively measure the rate of growth of vertebral bodies in juvenile idiopathic scoliosis (JIS) treated with vertebral body stapling (VBS). VBS has been suggested to be a safe and effective method for modulating the growth of the young scoliotic spine, but few long-term studies have examined its efficacy. Seven patients with JIS 11years of age or younger underwent VBS with a minimum 6-year follow-up. Vertebral body height on the unstapled and stapled aspects of the curve was measured from initial and final postoperative radiographs and converted into rate of growth per year. Known staple dimensions were used to standardize the measurements between radiographs. Interstaple distance was measured to demonstrate continued growth of the spine. Adjacent vertebral bodies without instrumentation served as an internal control of growth. Each vertebral body (n = 35) was analyzed as an individual experimental unit. The average rate of growth was 0.86mm/year (standard deviation [SD] 0.44, 95% confidence interval [CI] 0.71-1.0) per vertebral body on the stapled side and 0.83mm/year (SD 0.46, 95% CI 0.67-0.98) per vertebral body on the unstapled side of the vertebral body. The adjacent vertebral body segments grew at a rate of 0.91mm/year (SD 0.42, 95% CI 0.66-1.15) on the stapled side and 0.99mm/year (SD 0.66, 95% CI 0.61-1.37) on the unstapled side, p < 0.01. The distance between staples increased significantly from 3.0mm (SD 2.0, 95% CI 2.3-3.6) to 8.4mm (SD 2.4, 95% CI 7.7-9.3). Vertebral body growth in the presence of VBS occurred at a similar rate on the stapled and unstapled sides of the curve. The high standard deviation of instrumented segment growth further supports the conclusion that VBS is not a reliable method of growth modulation in the young scoliotic spine. IV.

Treatment of early-onset scoliosis: techniques, indications, and complications.

The treatments for early-onset scoliosis (EOS) remain great challenges for spine surgeons. This study aimed to comprehensively review the treatments for EOS, especially the advancements made in the last decade. Current studies on EOS were retrieved through a search on PubMed, UpToDate, the Web of Science Core Collection and Scopus were reviewed. The most pertinent information related to the current treatments for EOS was collected. The foci of treatments for EOS have included creating a well-developed thoracic cavity, improving lung volume, and improving pulmonary function. Conservative treatments include bracing, casting, halo-gravity traction, and physiotherapy. Serial casting is the most effective conservative treatment for EOS. Surgical treatments mainly include growth-friendly techniques, which are generally classified into three types according to the amount of correction force applied: distraction-based, compression-based, and growth-guided. The distraction-based systems include traditional or conventional growing rods, magnetically controlled growing rods, and vertical expandable prosthesis titanium ribs. The compression-based systems include vertebral body stapling and tethering. The growth-guided systems include the Shilla system and modern Luque trolley. In addition, some newer techniques have emerged in recent years, such as posterior dynamic deformity correction (ApiFix). For EOS patients presenting with sharp deformities in a long, congenital spinal deformity, a hybrid technique, one-stage posterior osteotomy with short segmental fusion and dual growing rods, may be a good choice. Hemivertebra resection is the gold standard for congenital scoliosis caused by single hemivertebra. Although the patient's growth potential is preserved in growth-friendly surgeries, a high complication rate should be expected, as well as a prolonged treatment duration and additional costs. Knowledge about EOS and its treatment options is rapidly expanding. Conservative treatments have specific limitations. For curves requiring a surgical intervention, surgical techniques may vary depending on the patients’ characteristics, the surgeon's experience, and the actual state of the country.

Treatment of Idiopathic Scoliosis With Vertebral Body Stapling

Study DesignRetrospective cohort. ObjectivesIdentify the effectiveness of vertebral body stapling (VBS) in children with idiopathic scoliosis. Summary of Background DataVBS 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. MethodsTen 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. ResultsTen 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. ConclusionsAlthough 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 EvidenceLevel III.

Idiopathic Scoliosis in Children and Adolescents: Emerging Techniques in Surgical Treatment

Idiopathic scoliosis is the most common spinal disorder in the pediatric population. The goals of treatment for pediatric idiopathic scoliosis are to correct deformity, prevent curve progression, restore trunk symmetry and balance, and minimize pain and morbidity. Surgical treatment has advanced significantly, from the advent of segmental pedicle screw instrumentation several decades ago to the recent development of robotic-assisted surgery and growth-modulating fusionless surgery. The objective of the present study was to review the reported data on emerging techniques in the surgical treatment of idiopathic scoliosis in children and adolescents. The PubMed and Google Scholar electronic databases were used to identify studies that had examined new emerging techniques in the surgical treatment of idiopathic scoliosis in children and adolescents. Major developments in the surgical techniques for pediatric idiopathic scoliosis have included robotic-assisted pedicle screw placement, vertebral body stapling, vertebral body tethering, magnetically controlled growing rods, ApiFix (not currently approved for use in the United States by the Food and Drug Administration), and sublaminar polyester bands. Such growth-modulating fusionless surgical techniques have received increasing attention in recent years, especially for the younger pediatric scoliosis population with significant growth potential remaining. Various emerging techniques in the surgical treatment of idiopathic scoliosis in children and adolescents have demonstrated promising results in the reported data thus far. However, longer term prospective studies with larger cohorts are necessary to better evaluate their safety and efficacy.

Alternatives to spinal fusion surgery in pediatric deformity

The standard of care for skeletally immature patients with idiopathic scoliosis is bracing for moderate curves. The standard of care for both skeletally immature and mature patients who have more severe or progressive curves is spinal fusion. We present a summary of four currently used non-fusion surgical techniques as alternatives to bracing and spinal fusion. Vertebral body stapling (VBS) is suggested for patients between the ages of 8 and 13 yr for girls and younger than 15 yr for boys with at least one year of growth remaining (Risser 0-1, Sanders digital stage ≤4). Thoracic curves should measure 25-35 degrees and lumbar curves 25-45 degrees. For best results, the curves should be flexible, bending to &lt; 20 degrees. Correction with a cord/screw construct includes vertebral body tethering (VBT) and anterior scoliosis correction (ASC), which are most commonly being performed for skeletally immature patients (Risser 0-2, Sanders digital stage ≤4) with thoracic and lumbar curves between 30-70 degrees that bend to &lt; 30 degrees. The authors of this article have expanded the indications for treating adolescents with idiopathic scoliosis who are more mature (Risser &gt; 2) with ASC. One commercial product has received CE mark approval in Europe for ASC treatment in both skeletally immature and mature patients. A second product utilizing posterior dynamic concave distraction, also with CE mark approval in Europe, is indicated for patients who are 10-17 yr old with primary single main thoracic or thoracolumbar curves between 30-60 degrees that correct to ≤35 degrees on bending films.

Continued Thoracic Growth in Patients with Juvenile Idiopathic Scoliosis (JIS) Following Vertebral Body Stapling (VBS)

Continued Thoracic Growth in Patients with Juvenile Idiopathic Scoliosis (JIS) Following Vertebral Body Stapling (VBS)

Factors Predictive of Outcomes in Vertebral Body Stapling for Idiopathic Scoliosis

Study DesignRetrospective review. ObjectivesTo identify factors associated with successful outcomes in patients treated with vertebral body stapling (VBS) for idiopathic scoliosis. Summary of Background DataThe standard of care for moderate scoliosis (20°–45°) consists of observation and bracing with the goal of halting curve progression. Although several recent studies have confirmed the efficacy of bracing in altering the natural history of scoliosis, bracing is not universally effective. Recent studies have demonstrated that VBS is a safe and viable treatment for some young patients with scoliosis at risk for progression. The identification of factors associated with successful outcomes in VBS for idiopathic scoliosis would better define the population likely to benefit from VBS. MethodsWe retrospectively reviewed all patients from a single institution treated with VBS who met previously defined inclusion criteria. Successful treatment was defined as avoidance of a fusion and a final Cobb angle no more than 10° greater than the pretreatment Cobb angle. ResultsWe identified 63 patients who met inclusion criteria. The patients underwent VBS at a mean age of 10.78 years and had a mean follow-up of 3.62 years (minimum 2 years). The mean pre-op Cobb angle for stapled thoracic curves was 29.5°. Seventy-four percent of the patients who had VBS of the thoracic curve have avoided progression and/or fusion, and the mean Cobb angle at most recent follow-up was 21.8°. The mean preoperative Cobb angle for lumbar curves was 31.1°. Eighty-two percent of the patients who had VBS of the lumbar curve have avoided progression and/or fusion, and their mean Cobb angle at follow-up was 21.6°. ConclusionVBS is effective at preventing progression and fusion for moderate idiopathic scoliosis in immature patients. The complication rates are low.

Anterior Scoliosis Correction in Immature Patients with Idiopathic Scoliosis

The current standard of care for skeletally immature patients with progressive scoliosis measuring >25° is a thoracolumbosacral orthosis. Recent evidence has established the efficacy of bracing in halting curve progression in patients with curves measuring 20°-40°. However, issues surrounding psychosocial impact, compliance, and the efficacy of bracing in larger curves remain. In patients with significant growth remaining, anterior growth modulation surgery has been established as a unique and promising alternative. Using a patient׳s remaining growth, vertebral body stapling and vertebral body tethering (VBT) exert compressive forces along the convexity of the deformity to wield control over coronal curvatures. Extensive preclinical studies have established the biomechanical foundation for stapling and tethering, and while clinical reports are still few, initial data have shown these procedures to be a promising treatment option in select patients. Vertebral body stapling is best employed for smaller, more flexible curves in younger patients, primarily as an alternative to bracing (thoracic curves

Vertebral Body Stapling for Moderate Juvenile and Early Adolescent Idiopathic Scoliosis: Cautions and Patient Selection Criteria.

Single-surgeon retrospective case series. 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. 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. 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. 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. 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. 4.

Growth modulation techniques for adolescent idiopathic scoliosis

Skeletally immature patients with idiopathic scoliosis are at high risk for curve progression. While bracing may be effective for a subset, there exists a need for the development of alternative treatments for these patients. Growth modulation techniques, such as vertebral body stapling and vertebral body tethering, offer a fusionless option, which harnesses a patient׳s remaining growth to progressively correct the curve. These techniques offer a promising alternative to appropriately selected skeletally immature patients with idiopathic scoliosis.

Vertebral Body Stapling in Children Younger Than 10 Years With Idiopathic Scoliosis With Curve Magnitude of 30° to 39°

Dual-center, retrospective study. To evaluate whether vertebral body stapling (VBS) influences curve progression between 30° and 39° in children younger than 10 years with idiopathic scoliosis. Patients younger than 10 years with idiopathic scoliosis of more than 30° have a 100% risk of progression to spine fusion regardless of nonoperative treatment. VBS may represent an alternative fusionless treatment option for this group of high-risk patients. Patients younger than 10 years with idiopathic thoracic or lumbar scoliosis of 30° to 39° who were treated with VBS with a minimum of 24 months of follow-up were studied. Outcome variables were curve progression and magnitude, surgical complications, and a need for reoperation. Preoperative and postoperative curve magnitudes were compared using a paired Student t test. Postoperative curve magnitudes were compared with one another using a paired Student t test. A P value of less than 0.05 was defined as statistically significant. Twelve patients were studied (female: n = 12; average age: 7.8 yr [range: 6.3-9.7 yr]). Thirteen curves were treated with VBS (thoracic: n = 9; lumbar: n = 4). The average follow-up was 3.4 years (range: 2.2-5.4 yr). The average preoperative curve magnitude was 33.4° (range: 30°-39°). The immediate postoperative curve magnitude (19.0°; range: 0°-29°) and curve magnitude at the most recent follow-up (23.0°; range: 10°-34°) were significantly less than the preoperative magnitude of 33.4°. Both thoracic curves (100%) and lumbar curves (100%) were treated successfully. Curve magnitudes did not change significantly postoperatively between the first erect radiographs and the most recent follow-up. Two patients had pneumothorax, and 1 patient had symptomatic pleural effusion. No patient required definitive fusion for curve progression. VBS is effective in controlling curve progression in the high-risk group of children younger than 10 years with idiopathic scoliosis between 30° and 39° in whom bracing may be ineffective.

Vertebral body stapling in children with idiopathic scoliosis &lt; 10 years old with curve magnitude 30-39 degrees

Vertebral body stapling in children with idiopathic scoliosis &lt; 10 years old with curve magnitude 30-39 degrees

Thoracoscopic Vertebral Body Stapling for Treatment of Scoliosis in Young Children

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.

Clinical Outcomes of Nitinol Staples for Preventing Curve Progression in Idiopathic Scoliosis

Although bracing for idiopathic scoliosis is moderately successful, its efficacy has been called into question and it carries associated psychosocial ramifications. In this study we report the background, rationale, indications, surgical techniques, and early results of vertebral body stapling (VBS) in patients with idiopathic scoliosis. We reviewed the literature on growth modulation of the growing spine and the concepts behind the use of VBS as a fusionless strategy. The indications are derived from retrospectively reviewed patients with idiopathic scoliosis treated with VBS followed for a minimum of 2 years. Indications for staple use included: (a) age <13 years in girls and 15 in boys, (b) Risser 0 or 1 and/or 1 year of growth remaining on wrist radiograph, (c) coronal curve <45 degrees with minimal rotation and flexible to <25 degrees on a side bending radiograph, and (d) sagittal thoracic curve <40 degrees. Thoracic curves measuring <35 degrees had a success rate of 77.7%. Curves which reached ≤ 20 degrees on first erect radiograph had a success rate of 85.7%. Thoracic curves greater than 35 degrees were not successful and require alternative treatments. Lumbar curves demonstrated a success rate of 86.7%. Some patients with idiopathic scoliosis with moderate curves (25 to 45 degrees) and high risk of progression can be safely treated with VBS as an alternative to bracing. Level III.

Vertebral Body Stapling

Retrospective review. To report the results of vertebral body stapling (VBS) with minimum 2-year follow-up in patients with idiopathic scoliosis. While bracing for idiopathic scoliosis is moderately successful, its efficacy has been called into question, and it carries associated psychosocial ramifications. VBS has been shown to be a safe, feasible alternative to bracing for idiopathic scoliosis. We retrospectively reviewed 28 of 29 patients (96%) with idiopathic scoliosis treated with VBS followed for a minimum of 2 years. Risser sign of 0 or 1 and coronal curve measuring between 20 degrees and 45 degrees . There were 26 thoracic and 15 lumbar curves. Average follow-up was 3.2 years. The procedure was considered a success if curves corrected to within 10 degrees of preoperative measurement or decreased >10 degrees . Thoracic curves measuring <35 degrees had a success rate of 77.7%. Curves which reached < or =20 degrees on first erect radiograph had a success rate of 85.7%. Flexible curves >50% correction on bend film had a success rate of 71.4%. Of the 26 curves, 4 (15%) showed correction >10 degrees. Kyphosis improved in 7 patients with preoperative hypokyphosis (<10 degrees of kyphosis T5-T12). Of the patients, 83.5% had remaining normal thoracic kyphosis of 10 degrees to 40 degrees. Lumbar curves demonstrated a success rate of 86.7%. Four of the 15 lumbar curves (27%) showed correction >10 degrees. Major complications include rupture of a unrecognized congenital diaphragmatic hernia and curve overcorrection in 1 patient. Two minor complications included superior mesenteric artery syndrome and atelectasis due to a mucous plug. There were no instances of staple dislodgement or neurovascular injury. Analysis of patients with idiopathic scoliosis (IS) with high-risk progression treated with vertebral body stapling (VBS) and minimum 2-year follow-up shows a success rate of 87% in all lumbar curves and in 79% of thoracic curves <35 degrees. Thoracic curves >35 degrees were not successful and require alternative treatments.

Ergebnisse der Behandlung von progredienten Skoliosen mit SMA-Klammern

Anterior vertebral body stapling is a new minimally invasive technique to correct scoliotic deformities without fusion. In the literature only preliminary reports with short follow-up periods are available. A total of six patients with a minimum follow-up of 2 years were available for examination. Of the six patients four demonstrated progression of scoliosis in spite of vertebral body stapling. All had curves of more than 35 degrees at the time of surgery, while two patients with less extensive curves below 35 degrees did not show signs of progression. Major complications were not observed. Vertebral body stapling for curves more than 35 degrees does not seem to be indicated and careful patient selection for stapling may be indicated for curves less than 35 degrees . A more general use of this technique is not recommended at this time.

Vertebral Body Stapling Procedure for the Treatment of Scoliosis in the Growing Child

Thirty-nine consecutive patients have had vertebral body stapling of 52 curves (26 patients with one curve stapled and 13 with two). For the group with patients who were 8 years or older with less than 50 degrees preoperative curve and a minimum 1-year followup, coronal curve stability was 87% when defined by progression less than or equal to 10 degrees . Fusion was necessary in two patients. No curves less than 30 degrees at the time of stapling progressed greater than or equal to 10 degrees . Major complications occurred in one patient (2.6%, diaphragmatic hernia) and minor complications occurred in five patients (13%). Further followup of the patient cohort and further research into efficacy and indications are warranted.