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Thread: New VBS study for patients < 10 yo with curves 30* - 39*

  1. #1
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    New VBS study for patients < 10 yo with curves 30* - 39*

    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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    Abstract
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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
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

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    The first author is one of our residents. It's actually a pretty exciting study, but no one knows what's going to happen to these kids long term. There's concern that the staples might inhibit growth. They'll be using the same cohort to measure whether growth stops, and that will be the next study in this series.
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    Quote Originally Posted by LindaRacine View Post
    It's actually a pretty exciting study, but no one knows what's going to happen to these kids long term. There's concern that the staples might inhibit growth.
    Hey Linda,

    I'm actually quite surprised by this. I've actually never heard anybody (including Dr. Betz, whom Dr. Cahill trained under) voice any concerns about growth. In fact, as I understood it, that was a big plus that the staples should not inhibit growth. Maybe I am not understanding what you mean, but it's been 12 or so years since the inception of VBS, and so some of these kids have even reached skeletal maturity. I know one girl, an early VBS patient, who is now 20 or 21. I haven't heard anything about this potential problem.

    I guess the next study in the series will either confirm or contradict this - but I'd be extremely surprised, based on the patients I have followed, if this was an issue. Guess I am just a bit confused. I'm going to ask Dr. Betz about it when I next speak to him.

    Thanks for the interesting info, Linda - and thanks to Sharon for the original post.
    Last edited by mariaf; 08-27-2013 at 07:50 PM.
    mariaf305@yahoo.com
    Mom to David, age 17, braced June 2000 to March 2004
    Vertebral Body Stapling 3/10/04 for 40 degree curve (currently mid 20's)

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    Maria, I understand your point. I am not clean on why this isn't just a small study among several other, likely larger studies on VBS in early onset scoliosis. Unless there is some indication from the work already published that growth is potentially compromised, I cannot imagine why they think this is an open question at this point.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  5. #5
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    Quote Originally Posted by Pooka1 View Post
    Unless there is some indication from the work already published that growth is potentially compromised, I cannot imagine why they think this is an open question at this point.
    That's exactly where I was going, Sharon. Wondering if I missed something - or if there was some new or little-known indication of this. And my surprise was because I usually hear of things VBS-related if not from Janet or Dr. Betz, then from a parent who goes for a consult and has a long list of questions - word usually gets around pretty quickly.
    mariaf305@yahoo.com
    Mom to David, age 17, braced June 2000 to March 2004
    Vertebral Body Stapling 3/10/04 for 40 degree curve (currently mid 20's)

    https://www.facebook.com/groups/ScoliosisTethering/

    http://pediatricspinefoundation.org/

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    On another note, the results in terms of effectiveness were even better than I had hoped.

    It has long been the opinion of the doctors performing VBS that it is most effective for curves under 35 degrees. If a 9 or 10 year old child presented with, say, a curve of 28-32 degrees, and particularly if the curve was flexible, I would almost bet my house that VBS would help reduce the curve.

    The gray area has always been curves at or over 35 degrees. While there are definitely kids who have benefitted from VBS even in the 35-40 degree range, the rate of success was not nearly as high as the ‘under 35’ group.

    Another positive is that they indicate VBS might work even in patients where bracing was ineffective. Again, doctors could almost predict that if a curve was the type to respond well to bracing, then they would have an excellent chance of success with VBS.

    But the curves that were resistant to bracing were the wild cards. Glad to hear they feel that VBS has a shot even in those patients!
    mariaf305@yahoo.com
    Mom to David, age 17, braced June 2000 to March 2004
    Vertebral Body Stapling 3/10/04 for 40 degree curve (currently mid 20's)

    https://www.facebook.com/groups/ScoliosisTethering/

    http://pediatricspinefoundation.org/

  7. #7
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    Thanks for posting that article, Sharon. There wasn't much published about VBS last year that I could find, so it is good to see some new data published.

    Leah was not included in that study (because her surgery was at Shriner's St Louis), but she fits the criteria exactly. She was diagnosed at age 6 with a thoracic curve of 26 (measured 30 degrees by the radiologist, and we were told that "26 degrees and 30 degrees are the same curve" by the orthopedist). She was stapled at age 8 for a 29-30 degree curve after some miserable time in a brace, and is now 3 years post-op, definitely in her growth spurt. So far her curve is holding stable in the mid-teens.

    Dr Luhmann was extremely thorough in explaining risks/benefits to us. Loss of potential height was never mentioned, and like Maria, I have never heard mention of it. Leah is 1/2" shy of 5' now, at age 11, so I'm not too worried about her final height. However, I would gladly trade some loss of height for years in a brace followed by near-certain fusion.

    When she was diagnosed we were given a prognosis of 100% chance of fusion, with or without bracing. Our local pediatric scoliosis specialist felt that it wouldn't matter if we braced her or not, she would end up fused, and told us that bracing is for the parents, not for the child. For us VBS has been a great choice, something we will do for our son if his scoliosis ever progresses.
    Last edited by leahdragonfly; 08-28-2013 at 09:13 PM.
    Gayle, age 49
    Oct 2010 fusion T8-sacrum w/ pelvic fixation
    Feb 2012 lumbar revision for broken rods @ L2-3-4
    Sept 2015 major lumbar A/P revision for broken rods @ L5-S1


    mom of Leah, 15 y/o, Diagnosed '08 with 26* T JIS (age 6)
    5/10 VBS Dr Luhmann Shriners St Louis
    5/16 6 yrs post-op, 24*T/ 22* L, mild increase in curves, watching

    also mom of Torrey, 12 y/o son, 16* T, stable

  8. #8
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    Here's a link to a more complete presentation of the same research

    http://www.ucsfcme.com/2013/MMJ13008...939Degrees.pdf

    Two patients were over 35 degrees (one 38 and one 39), the others were between 30 and 35.

    He lists the effects on growth in the unknowns:

    Unknowns!
    – Lower age limit?
    – Children between 10 and puberty?
    – Effect on growth?
    – Overcorrection?
    – Larger curves (>40-45°)?

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