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 degrees and 35 degrees 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 degrees, 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 degrees (26 degrees -35 degrees). 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 degrees, 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.