Anterior growth modulation techniques: Vertebral body stapling

Vertebral body stapling (VBS) is a fusionless treatment alternative to observation and bracing for the growing child with moderate (20–45°) idiopathic scoliosis. Thoracic spine staples are inserted thoracoscopically, and thoracolumbar or lumbar staples are placed through a minimal access direct lateral retroperitoneal approach. The following indications and strategies are recommended for stapling: Age: less than 13 years in female and less than 15 years in males. Growth remaining: Risser 0–2; at least 1 year of remaining growth on wrist radiographs; and Sanders digital stage less than or equal to 4. Thoracic and lumbar coronal curve less than 45° with minimal rotation and flexible with side bending correction to less than 20°. Sagittal thoracic kyphosis less than 40°. Consider adding a posterior rib to the spine growing rod or VEPTR construct during the stapling procedure if the thoracic curve measures 35–45° and does not bend below 20°. Postoperative nighttime bracing should be used if the curve on the first erect film does not measure less than 20°.