Skip to main content

Advertisement

SpringerLink
Log in

Treatment of Idiopathic Scoliosis With Vertebral Body Stapling

  • Case Report
  • Published:
Spine Deformity Aims and scope Submit manuscript

Abstract

Study Design

Retrospective cohort.

Objectives

Identify the effectiveness of vertebral body stapling (VBS) in children with idiopathic scoliosis.

Summary of Background Data

VBS 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.

Methods

Ten 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.

Results

Ten 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.

Conclusions

Although 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 Evidence

Level III.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Danielsson AJ, Hasserius R, Ohlin A, Nachemson AL. A prospective study of brace treatment versus observation alone in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2007;32:2198–207.

    Article  Google Scholar 

  2. Allington NJ, Bowen JR. Adolescent idiopathic scoliosis: treatment with the Wilmington brace. A comparison of full-time and part-time use. J Bone Joint Surg Am 1996;78:1056–62.

    Article  CAS  PubMed  Google Scholar 

  3. Rowe DE, Bernstein SM, Riddick MF, et al. A meta-analysis of the efficacy of non-operative treatments for idiopathic scoliosis. J Bone Joint Surg Am 1997;79:664–74.

    Article  CAS  PubMed  Google Scholar 

  4. Peterson LE, Nachemson AL. Prediction of progression of the curve in girls who have adolescent idiopathic scoliosis of moderate severity. Logistic regression analysis based on data from The Brace Study of the Scoliosis Research Society. J Bone Joint Surg Am 1995;77:823–7.

    Article  CAS  PubMed  Google Scholar 

  5. Karol LA. Effectiveness of bracing in male patients with idiopathic scoliosis. Spine (Phila Pa 1976) 2001;26:2001–5.

    Article  CAS  Google Scholar 

  6. Nachemson AL, Peterson LE. Effectiveness of treatment with a brace in girls who have adolescent idiopathic scoliosis. A prospective, controlled study based on data from the Brace Study of the Scoliosis Research Society. J Bone Joint Surg Am 1995;77:815–22.

    Article  CAS  PubMed  Google Scholar 

  7. Weinstein SL, Dolan LA, Wright JG, Dobbs MB. Effects of bracing in adolescents with idiopathic scoliosis. N Engl J Med 2013;369:1512–21.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Yrjönen T, Ylikoski M, Schlenzka D, et al. Effectiveness of the Providence nighttime bracing in adolescent idiopathic scoliosis: a comparative study of 36 female patients. Eur Spine J 2006;15: 1139–43.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Rahman T, Bowen JR, Takemitsu M, Scott C. The association between brace compliance and outcome for patients with idiopathic scoliosis. J Pediatr Orthop 2005;25:420–2.

    Article  PubMed  Google Scholar 

  10. Wall EJ, Bylski-Austrow DI, Kolata RJ, Crawford AH. Endoscopic mechanical spinal hemiepiphysiodesis modifies spine growth. Spine (Phila Pa 1976) 2005;30:1148–53.

    Article  Google Scholar 

  11. Betz RR, Ranade A, Samdani AF, et al. Vertebral body stapling: a fusionless treatment option for a growing child with moderate idiopathic scoliosis. Spine (Phila Pa 1976) 2010;35:169–76.

    Article  Google Scholar 

  12. Lalonde NM, Aubin C-E, Pannetier R, Villemure I. Finite element modeling of vertebral body stapling applied for the correction of idiopathic scoliosis: preliminary results. Stud Health Technol Inform 2008;140:111–5.

    CAS  PubMed  Google Scholar 

  13. Puttlitz CM, Masaru F, Barkley A, et al. A biomechanical assessment of thoracic spine stapling. Spine (Phila Pa 1976) 2007;32:766–71.

    Article  Google Scholar 

  14. Zhang Y, Zhang W, Zheng G, et al. Experimental study on controlling unilateral spine growth by shape memory alloy staple [in Chinese]. Zhonghua Wai Ke Za Zhi 2007;45:537–9.

    Google Scholar 

  15. Braun JT, Hoffman M, Akyuz E, et al. Mechanical modulation of vertebral growth in the fusionless treatment of progressive scoliosis in an experimental model. Spine (Phila Pa 1976) 2006;31:1314–20.

    Article  Google Scholar 

  16. Newton PO, Farnsworth CL, Faro FD, et al. Spinal growth modulation with an anterolateral flexible tether in an immature bovine model. Spine (Phila Pa 1976) 2008;33:724–33.

    Article  Google Scholar 

  17. Ginsburg G, Mulconrey DS, Browdy J. Transpedicular hemiepiphysiodesis and posterior instrumentation as a treatment for congenital scoliosis. J Pediatr Orthop 2007;27:387–91.

    Article  Google Scholar 

  18. Trobisch PD, Samdani A, Cahill P, Betz RR. Vertebral body stapling as an alternative in the treatment of idiopathic scoliosis. Oper Orthop Traumatol 2011;23:227–31.

    Article  CAS  PubMed  Google Scholar 

  19. Theologis AA, Cahill P, Auriemma M, et al. Vertebral body stapling in children younger than 10 years with idiopathic scoliosis with curve magnitude of 30° to 39°. Spine (Phila Pa 1976) 2013;38:E1583–8.

    Article  Google Scholar 

  20. Laituri CA, Schwend RM, Holcomb 3rd GW. Thoracoscopic vertebral body stapling for treatment of scoliosis in young children. J Laparoendosc Adv Surg Tech A 2012;22:830–3.

    Article  PubMed  Google Scholar 

  21. Sarwark J. Growth considerations of the immature spine. J Bone Joint Surg Am 2007;89(suppl 1):8–13.

    Article  Google Scholar 

  22. Fletcher ND, Bruce RW. Early onset scoliosis: current concepts and controversies. Curr Rev Musculoskelet Med 2012;5:102–10.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Lavelle WF, Samdani AF, Cahill PJ, Betz RR. Clinical outcomes of nitinol staples for preventing curve progression in idiopathic scoliosis. J Pediatr Orthop 2011;31:S107–13.

    Article  PubMed  Google Scholar 

  24. Nachlas IW, Borden JN. The cure of experimental scoliosis by directed growth control. J Bone Joint Surg Am 1951;33 A:24–34.

    Article  CAS  PubMed  Google Scholar 

  25. Newton PO, Faro FD, Farnsworth CL, et al. Multilevel spinal growth modulation with an anterolateral flexible tether in an immature bovine model. Spine (Phila Pa 1976) 2005;30:2608–13.

    Article  Google Scholar 

  26. Braun JT, Akyuz E, Ogilvie JW. The use of animal models in fusionless scoliosis investigations. Spine (Phila Pa 1976) 2005;30(17 suppl):S35–45.

    Article  Google Scholar 

  27. Braun JT, Akyuz E, Udall H, et al. Three-dimensional analysis of 2 fusionless scoliosis treatments: a flexible ligament tether versus a rigid-shape memory alloy staple. Spine (Phila Pa 1976) 2006;31:262–8.

    Article  Google Scholar 

  28. Betz RR, Kim J, D’Andrea LP, et al. An innovative technique of vertebral body stapling for the treatment of patients with adolescent idiopathic scoliosis: a feasibility, safety, and utility study. Spine (Phila Pa 1976) 2003;28:S255–65. OD-2003/10/16.

    Article  Google Scholar 

  29. Cuddihy L, Danielsson AJ, Cahill PJ, et al. Vertebral body stapling versus bracing for patients with high-risk moderate idiopathic scoliosis. Biomed Res Int 2015;2015:1–7.

    Article  CAS  Google Scholar 

  30. Yaszay B, O’Brien M, Shufflebarger HL, et al. Efficacy of hemivertebra resection for congenital scoliosis. Spine (Phila Pa 1976) 2011;36:2052–60.

    Article  Google Scholar 

  31. Ruf M, Harms J. Posterior hemivertebra resection with transpedicular instrumentation: early correction in children aged 1 to 6 years. Spine (Phila Pa 1976) 2003;28:2132–8.

    Article  Google Scholar 

  32. Winter RB. Convex anterior and posterior hemiarthrodesis and hemi-epiphyseodesis in young children with progressive congenital scoliosis. J Pediatr Orthop 1981;1:361–6.

    Article  CAS  PubMed  Google Scholar 

  33. Keller PM, Lindseth RE, DeRosa GP. Progressive congenital scoliosis treatment using a transpedicular anterior and posterior convex hemiepiphysiodesis and hemiarthrodesis. A preliminary report. Spine (Phila Pa 1976) 1994;19:1933–9.

    Article  CAS  Google Scholar 

  34. King AG, MacEwen GD, Bose WJ. Transpedicular convex anterior hemiepiphysiodesis and posterior arthrodesis for progressive congenital scoliosis. Spine (Phila Pa 1976) 1992;17(8 suppl):S291–4.

    Article  CAS  Google Scholar 

  35. Smith AD, von Lackum WH, Wylie R. An operation for stapling vertebral bodies in congenital scoliosis. J Bone Joint Surg Am 1954;36:342–8.

    Article  CAS  PubMed  Google Scholar 

  36. Tis JE, Karlin LI, Akbarnia BA, et al. Early onset scoliosis: modern treatment and results. J Pediatr Orthop 2012;32:647–57.

    Article  PubMed  Google Scholar 

  37. Weinstein SL, Dolan LA. The evidence base for the prognosis and treatment of adolescent idiopathic scoliosis: the 2015 orthopaedic research and education foundation clinical research award. J Bone Joint Surg Am 2015;97:1899–903.

    Article  PubMed  Google Scholar 

  38. Henry M, Amor M, Beyar R, et al. Clinical experience with a new nitinol self-expanding stent in peripheral arteries. J Endovasc Surg 1996;3:369–79.

    Article  CAS  PubMed  Google Scholar 

  39. Bezzi M, Orsi F, Salvatori FM, et al. Self-expandable nitinol stent for the management of biliary obstruction: long-term clinical results. J Vasc Interv Radiol 1994;5:287–93.

    Article  CAS  PubMed  Google Scholar 

  40. Cragg AH, De Jong SC, Barnhart WH, et al. Nitinol intravascular stent: results of preclinical evaluation. Radiology 1993;189:775–8.

    Article  CAS  PubMed  Google Scholar 

  41. Hausegger KA, Cragg AH, Lammer J, et al. Iliac artery stent placement: clinical experience with a nitinol stent. Radiology 1994;190:199–202.

    Article  CAS  PubMed  Google Scholar 

  42. Fernandes P, Weinstein SL. Natural history of early onset scoliosis. J Bone Joint Surg Am 2007;89(suppl 1):21–33.

    Article  Google Scholar 

  43. Katz DE, Herring JA, Browne RH, et al. Brace wear control of curve progression in adolescent idiopathic scoliosis. J Bone Joint Surg Am 2010;92:1343–52.

    Article  PubMed  Google Scholar 

  44. Karol LA, Virostek D, Felton K, et al. The effect of the Risser stage on bracing outcome in adolescent idiopathic scoliosis. J Bone Joint Surg Am 2016;98:1253–9.

    Article  PubMed  Google Scholar 

  45. Bumpass DB, Fuhrhop SK, Schootman M, et al. Vertebral body stapling for moderate juvenile and early adolescent idiopathic scoliosis: cautions and patient selection criteria. Spine (Phila Pa 1976) 2015;40:E1305–14.

    Article  Google Scholar 

  46. Dimeglio A. Growth of the spine before age 5 years. J Pediatr Orthop B 1992;1:102–7.

    Article  Google Scholar 

  47. Emans JB, Kaelin A, Bancel P, et al. The Boston bracing system for idiopathic scoliosis. Follow-up results in 295 patients. Spine (Phila Pa 1976) 1986;11:792–801.

    Article  CAS  Google Scholar 

  48. Misterska E, Glowacki M, Latuszewska J. Female patients’ and parents’ assessment of deformity- and brace-related stress in the conservative treatment of adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2012;37:1218–23.

    Article  Google Scholar 

  49. Katz DE, Richards BS, Browne RH, Herring JA. A comparison between the Boston brace and the Charleston bending brace in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 1997;22:1302–12.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Morgan Stanley Children’s Hospital of New York-Presbyterian, Columbia University Medical Center, 370 Fort Washington Ave, Apt 306, 3959 Broadway, 10032, New York, NY, USA

    Evan Trupia MD, Anny C. Hsu MS, MD, Hiroko Matsumoto MS, PhD & Michael Vitale MD, PhD

  2. Columbia University Medical Center, CH-8N, 3959 Broadway, 10032, New York, NY, USA

    John D. Mueller BS

  3. Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, 10029, New York, NY, USA

    Lawrence Bodenstein MD, PhD

Authors
  1. Evan Trupia MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anny C. Hsu MS, MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. John D. Mueller BS
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hiroko Matsumoto MS, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lawrence Bodenstein MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Michael Vitale MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Evan Trupia MD.

Additional information

Author disclosures: ET (none), ACH (none), JDM (none), HM (grants from Pediatric Orthopaedic Society of North America [POSNA] and Scoliosis Research Society; personal fees from Children’s Spine Foundation, other from American Academy for Cerebral Palsy and Developmental Medicine [AACPDM], outside the submitted work), LB (none), MV (grants from POSNA, during the conduct of the study; other from POSNA, Biomet, and Wellinks; personal fees from Stryker, Biomet, and Medtronic, outside the submitted work).

IRB approval: IRB-AAAO8862. This work is approved by the Institutional Review Board (IRB) of Columbia University.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Trupia, E., Hsu, A.C., Mueller, J.D. et al. Treatment of Idiopathic Scoliosis With Vertebral Body Stapling. Spine Deform 7, 720–728 (2019). https://doi.org/10.1016/j.jspd.2019.01.006

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1016/j.jspd.2019.01.006

Keywords

Search

Navigation