Vertebral body stapling: A fusionless treatment option for a growing child with moderate idiopathic scoliosis

Study Design: Retrospective review. Objective: To report the results of vertebral body stapling (VBS) with minimum 2-year follow-up in patients with idiopathic scoliosis. Summary of Background Data: 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. Methods: We retrospectively reviewed 28 of 29 patients (96%) with idiopathic scoliosis treated with VBS followed for a minimum of 2 years. Inclusion criteria: Risser sign of 0 or 1 and coronal curve measuring between 20° and 45°. Results: 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° of preoperative measurement or decreased >10°. Thoracic curves measuring <35° had a success rate of 77.7%. Curves which reached ≤20° 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°. Kyphosis improved in 7 patients with preoperative hypokyphosis (<10° of kyphosis T5-T12). Of the patients, 83.5% had remaining normal thoracic kyphosis of 10°to 40°. Lumbar curves demonstrated a success rate of 86.7%. Four of the 15 lumbar curves (27%) showed correction >10°. 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. Conclusion: 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°. Thoracic curves >35° were not successful and require alternative treatments.