Vertebral Body Stapling in Children With Idiopathic Scoliosis < 10 Years of Age With Curve Magnitude 30 - 39 Degrees

Theologis, Alexander A.; Cahill, Patrick; Auriemma, Mike; More

Spine., POST ACCEPTANCE, 16 August 2013

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Study Design. Dual-center, retrospective study

Objective. To evaluate whether vertebral body stapling (VBS) influences progression in children < 10 years old with idiopathic scoliosis between 30 and 390.

Summary of Background Data. Patients <10 years old with idiopathic scoliosis > 300 have a 100% risk of progression to spine fusion regardless of non-operative treatment. VBS may represent an alternative fusionless treatment for this group of high-risk patients.

Methods. Patients <10 years old with idiopathic thoracic or lumbar scoliosis 30-390 who were treated with VBS with a minimum of 24 months of follow-up were studied. Outcome variables were curve progression and magnitude, surgical complications, and need for re-operation. Pre-operative and post-operative curve magnitudes were compared using a paired student t-test. Post-operative curve magnitudes were compared to one another using a paired student t-test. A p-value < 0.05 was defined as statistical significance.

Results. Twelve patients were studied [female - 12; average age 7.8 years, (6.3 - 9.7 years)]. Thirteen curves were treated with VBS (thoracic - 9; lumbar - 4). The average follow-up was 3.4 years (2.2-5.4 years). The average pre-operative curve magnitude was 33.40 (30-390). The immediate post-operative curve magnitude (19.00; 0-290) and curve magnitude at most recent follow-up (23.00; 10-340) were significantly less than the pre-operative magnitude of 33.40. 100% of thoracic curves and 100% of lumbar curves were treated successfully. Curve magnitudes did not change significantly post-operatively between the 1st erect radiographs and the most recent follow-up. Two patients had a pneumothorax and one patient had a symptomatic pleural effusion. No patient required definitive fusion for curve progression.

Conclusion. Vertebral body stapling is effective in controlling curve progression in the high risk group of children <10 years old who present with idiopathic scoliosis between 30[degrees] and 39[degrees], in whom bracing may be ineffective.

(C) 2013 by Lippincott Williams & Wilkins