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Vertebral body stapling as an alternative in the treatment of idiopathic scoliosis

Wirbelsäulenklammerung als Alternative bei der Behandlung einer idiopathischen Skoliose

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Abstract

Objective

Unilateral vertebral body stapling as a fusionless alternative to control curvature progression in patients with idiopathic scoliosis (IS).

Indications

Skeletally immature patients (Risser 0 or 1) with IS measuring 20–45° and correction of the curvature <20° on side-bending X-rays.

Contraindications

Congenital scoliosis, curvature above T4 or below L4, thoracic kyphosis >40°.

Surgical technique

Unilateral disc-sparing staples are placed at the convex side. A thoracoscopic approach can be used for thoracic curves and a mini-open retroperitoneal approach for lumbar curves.

Postoperative management

Early ambulation on postoperative day 1 is encouraged. There are no absolute activity restrictions, and no bracing beyond 4 weeks is required.

Results

A total of 28 patients (4 males, 24 females; average age at operation 9.4 years) met all inclusion criteria and had a minimum 2-year follow-up (range 2–5.3 years). The success rate (improvement or stabilization of the curvature) was 86% for thoracic curves <35° and all lumbar curves meeting the indications.

Zusammenfassung

Operationsziel

Verhinderung einer Kurvenprogression bei idiopathischer Skoliose (IS) durch eine nicht versteifende unilaterale Wirbelkörperklammerung.

Indikationen

IS-Patienten ohne abgeschlossenes Knochenwachstum (Risser 0 oder 1) mit einer Kurvenausprägung zwischen 20° und 45° sowie einer Korrektur der Krümmung auf unter 20° in seitlichen Bending-Röntgenaufnahmen.

Kontraindikationen

Kongenitale Skoliosen, Krümmung oberhalb von T4 oder unterhalb von L4, thorakale Hyperkyphosen >40°.

Operationstechnik

Unilaterale, die Bandscheiben überbrückende Klammerung der Wirbelkörper an der konvexen Seite. Bei thorakaler Krümmung bietet sich eine thorakoskopische Technik an und bei lumbaler Krümmung eine Mini-open-Technik mit retroperitonealem Zugang.

Weiterbehandlung

Frühe Mobilisierung am ersten postoperativen Tag wird angestrebt. Es gibt keine absoluten Einschränkungen. Eine kurzzeitige Korsetttherapie ist nicht länger als 4 Wochen nötig.

Ergebnisse

Insgesamt erfüllten 28 Patienten (4 Jungen, 24 Mädchen; durchschnittliches Alter bei Operation 9,4 Jahre) alle Einschlusskriterien. Der Follow-up-Zeitraum betrug 2 Jahre (2–5,3 Jahre). Die Erfolgsrate (Besserung oder Stabilisierung der Krümmung) lag für thorakale Kurven <35° sowie für alle lumbale Kurven, die Indikationskriterien erfüllten, bei 86%.

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Conflict of interest

The corresponding author states that A.F. Samdani, P. Cahill, and R.R. Betz have received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this manuscript, e.g., honoraria, gifts, consultancies, royalties, stocks, stock options, decision-making positions. D. Trobisch declares that no benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

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Authors and Affiliations

  1. Dept. of Orthopedics, Shriners Hospital for Children, 3551 N Broad Street, 19140, Philadelphia, PA, USA

    P.D. Trobisch, A. Samdani, P. Cahill & R.R. Betz

Authors
  1. P.D. Trobisch
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  2. A. Samdani
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  3. P. Cahill
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  4. R.R. Betz
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Corresponding author

Correspondence to P.D. Trobisch.

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Trobisch, P., Samdani, A., Cahill, P. et al. Vertebral body stapling as an alternative in the treatment of idiopathic scoliosis. Oper Orthop Traumatol 23, 227–231 (2011). https://doi.org/10.1007/s00064-011-0032-z

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  • DOI: https://doi.org/10.1007/s00064-011-0032-z

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