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Thread: Vertebral Stapling

  1. #1
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    Vertebral Stapling

    I'd like to draw your attention to the fact that not only is dr. Braun quite the cutie patootie but he is also quite brilliant! Here is a presentation from the latest SRS meeting which discusses some of the findings on vertebral stapling. The discussion immediately following the presentation is also very interesting.



    http://www.istreamplanet.com/srs/def...nfgroup=Annual

    42nd Annual Meeting



    Friday Sessions
    10:26am Can Fusionless Scoliosis Surgery Reverse the Heuter-Volkmann Effect? play4
    John Braun
    067

    Canadian eh
    Daughter, Deirdre born Oct 2000. Diagnosed with 60 degree curve at the age of 19 months. Serial casting by Dr. Hedden at Sick Kid's Hospital. Currently being treated by Dr. Rivard and Dr. Coillard in Montreal with the Spinecor brace and curve is holding at "2" degrees. Next appointment 2008

  2. #2
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    Dr. Linda D'Andrea also had a nice presentation on non-fusion surgery (ie, stapling) at the SRS conference. I believe her presentation is on the first day - pre-course schedule.
    Carmell
    mom to Kara, idiopathic scoliosis, Blake 19, GERD and Braydon 14, VACTERL, GERD, DGE, VEPTR #137, thoracic insufficiency, rib anomalies, congenital scoliosis, missing coccyx, fatty filum/TC, anal stenosis, horseshoe kidney, dbl ureter in left kidney, ureterocele, kidney reflux, neurogenic bladder, bilateral hip dysplasia, right leg/foot dyplasia, tibial torsion, clubfoot with 8 toes, pes cavus, single umblilical artery, etc. http://carmellb-ivil.tripod.com/myfamily/

  3. #3
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    The pre-course is amazing resource for congenital scoliosis, it deals almost entirely with the topic. I found the non-operative presentation by dr. Zeller interesting. Here is the abstract by dr. Braun and colleagues on fusionless surgery that won the Hibbs award at the conference.


    2007 Award Winners
    Paper #66
    Hibbs Award Nominee for Best Basic Science Presentation

    The Effect Of Two Clinically Relevant Fusionless Scoliosis Implant Strategies On The Health of the Intervertebral Disc

    Kenneth J. Hunt, MD; John T. Braun, MD; Bryt A. Christensen, BS

    Introduction: Fusionless scoliosis surgery is thought to be more physiologic than fusion and, thus, less likely to cause disc degeneration, particularly at adjacent segments. However, there are no data supporting this belief. This study evaluates the effect of clinically relevant fusionless scoliosis surgery implants on the health of instrumented and sub-adjacent discs. We hypothesize that flexible implants will result in less damage to the discs than rigid implants.

    Methods: Scoliosis was created in twelve 8-week-old female goats using two fusionless scoliosis implant strategies from T7-T12. Three groups were studied: 2 SMA staples per level, submaximally tensioned bone anchor/ligament tether (BALT) and untreated controls (n=6 per group). At six months, instrumented and sub-adjacent discs were harvested. Qualitative and quantitative analyses were performed using H & E sections on the discs (cell density and fibrosis), endplates (concave endplate and trabecular thickening, tidemark flattening, bone drift) and surrounding vascularity.

    Results: Scoliosis was created in both treatment groups but not controls. All instrumented discs demonstrated a trend toward decreased cell density compared to sub-adjacent discs and controls but no difference between sub-adjacent discs and controls. Endplate/trabecular thickening and bone drift were present in all instrumented discs, but not in sub-adjacent discs or controls. Decreased blood vessel density was present in all instrumented endplates compared to sub-adjacent and control specimens (p=0.012). There was no difference in vascularity between sub-adjacent and control endplates or between convex and concave endplates.

    Conclusion: The data in this study demonstrate that both rigid and flexible fusionless scoliosis implants induce some degenerative change at the instrumented disc (reduced cell density) and endplate (thickening, loss of vascularity) but spare the sub-adjacent segment. There were no differences between flexible and rigid implants. Further analysis is necessary to define conditions that optimize scoliosis correction with minimal detrimental effects.

    Significance: This study improves our understanding of clinically relevant fusionless scoliosis implant strategies and their effect on the intervertebral discs
    .

    Canadian eh
    Daughter, Deirdre born Oct 2000. Diagnosed with 60 degree curve at the age of 19 months. Serial casting by Dr. Hedden at Sick Kid's Hospital. Currently being treated by Dr. Rivard and Dr. Coillard in Montreal with the Spinecor brace and curve is holding at "2" degrees. Next appointment 2008

  4. #4
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    Is it just me? Doesn't it worry anybody else that they're still testing these staples on goats and other live animals and at the same time performing experimental surgery on children with a non malignant condition?

    Canadian eh
    Daughter, Deirdre born Oct 2000. Diagnosed with 60 degree curve at the age of 19 months. Serial casting by Dr. Hedden at Sick Kid's Hospital. Currently being treated by Dr. Rivard and Dr. Coillard in Montreal with the Spinecor brace and curve is holding at "2" degrees. Next appointment 2008

  5. #5
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    Celia,

    I am not sure VBS is still considered "Experimental" as you say. I think it is just coming out of it's experimental phase and entering it's doing well phase, perhaps better even than bracing. We need a few more years to say for sure. Other very well known surgeons are beginning to recommend this as a viable option to a long time serving in a brace. In fact, a very well known and prominent surgeon in Manhatten, Dr Boachie, was the first to mention VBS to me, as an alternative to 6 or 7 years in any brace. Which many would consider unbearable.

    They are still performing many procedures on animals. Goats etc..... Even some types of heart surgery are still being done on animals. This is how the medical world makes pre existing procedures better!!

    Medicine and science are not as exact as many would like to believe. They are constantly being upgraded, and made better, more convenient, or less invasive.

    God bless the doctors who are the pioneers and the patients who believe in them!! For all of us benefit!!

    I see from your signature that your own child was in a serial cast for some time. Many would consider that cruel and unusual treatment of a child. But you and I know better. You gave your daughter the very best as you believed it to be... right?!?

    Stephanie
    Mom to Michela ~age 12 ~VBS @ age 9 - 12/19/07 26* to 1*
    10/8/08 ~ curve is immeasurable!!
    07/16/09 ~ a few degrees overcorrected... being monitored
    12/28/09 ~ 14* overcorrected to the right
    2/23/10 ~ 12* overcorrected
    3/12/10 ~ Boston Brace at night to prevent further overcorrection. In brace corrects to -8*

  6. #6
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    I think it's just plain wrong to compare vertebral stapling to bracing because one is an experimental surgical procedure and the other is not! If vertebral stapling is an alternative to bracing then it should meet the new SRS standardized criteria for bracing before they can make the following statement:

    the results in this early cohort of patients showed curve stability after vertebral body stapling to be 87% when defined by progression less than or equal to 10 degrees

    If anything, vertebral stapling should be considered an alternative to other surgical procedures such as growth rods. The following statement in the same article is also very misleading!

    Of 31 patients aged 8 years or older at the time of surgery, 21 patients with 12 months or more of followup and a preoperative curve measuring less than 50 degrees were reviewed ( figure 4). These 21 patients had 25 curves stapled. The average time of followup was 1.6 years and the average preoperative curve measured 33 degrees ( range 20 - 40). Three of the 25 (13%) of the curves progressed greater than 10 degrees. None of the 8 preoperative curves less than 30 degrees progressed, whereas three of the 17 (18%) of the preoperative curves greater than or equal to 30 degrees did progress.


    Keep in mind how they define progression... it states that no child with a curve under 30 degrees progressed.... what they mean to say is that no child with a curve under 30 progressed more than 10 degrees! Curves that progressed less than 10 degrees say 8 degrees were not considered in the criteria for failure or progression. Given the short followup period, a curve that started at 28 degrees and is now 36 degrees would be in the success group!!!

    Canadian eh
    Daughter, Deirdre born Oct 2000. Diagnosed with 60 degree curve at the age of 19 months. Serial casting by Dr. Hedden at Sick Kid's Hospital. Currently being treated by Dr. Rivard and Dr. Coillard in Montreal with the Spinecor brace and curve is holding at "2" degrees. Next appointment 2008

  7. #7
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    Quote Originally Posted by stephanieC
    Other very well known surgeons are beginning to recommend this as a viable option to a long time serving in a brace. In fact, a very well known and prominent surgeon in Manhatten, Dr Boachie, was the first to mention VBS to me, as an alternative to 6 or 7 years in any brace. Which many would consider unbearable.

    God bless the doctors who are the pioneers and the patients who believe in them!! For all of us benefit!!

    I see from your signature that your own child was in a serial cast for some time. Many would consider that cruel and unusual treatment of a child. But you and I know better. You gave your daughter the very best as you believed it to be... right?!?

    Stephanie
    What a well written post, Stephanie.

    In addition to Dr. Boachie, Dr. Skaggs in LA, and Drs. Emans and Hresko in Boston are just a few of the other very well known orthopedic surgeons who are starting to perform the VS procedure. Seems that some of the best orthos in the country think it is a very viable option. I'm sure some of that has to do with the high success rate so far and the fact that unlike braces, the VS seems to very often actually reduce the curve.

    Unfortunately, some people feel they know better AND know what is best for your child and everyone else's - you will never win this argument so my advice to you my dear is to just let it go. Some people don't give parents the credit they deserve for being capable of doing research, weighing options and making an educated decision for their child.

    By the way, now you know how everyone says they love the VS support site - because the folks are supportive and helpful and "nobody is ARGUMENTATIVE and negative like on some other sites". We've both heard that said time and time again - and now you just witnessed first hand what everyone was talking about

    See you on the VS support site Stephanie!

    p.s. It's a shame that you, like so many others considering the VS procedure, will probably avoid this site and stick to groups where parents actually support each other's decisions.

    Too bad.
    Last edited by mariaf; 11-16-2007 at 08:33 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)

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

    http://pediatricspinefoundation.org/

  8. #8
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    Celia,

    Don't be silly. You are being misleading. Of course stapling is an option comparable to bracing. It IS an internal brace. It allows for mobility and flexibility similar to the rational behind spine cor. You just don't have to put the brace on and wear it for 20 hours everyday for X amount of years. It is always with you supporting your spine. A person would either do the VBS or the bracing when the curve has progressed to the mid twenties or so. (some earlier, some later. Depends on so many things))

    I believe it is a personal philosophy that a parent holds. Do I do the spine cor and have my child endure years of discomfort and emotional and psychological issues or, do I do the stapling and risk the surgery, offering my child a "normal" brace free childhood. I am not even saying that one is per say better than the other. It's a personal philosophy. I looked into spine cor at great length, believing it to be the only "brace" option that my child may have been able to tolerate. But for me and my daughter, I believe the VBS to be a better solution. The surgery is not without risk, but the outcomes for most children who have gone through it have been fantastic. If you don't know this, then you haven't been listening to what many parents here on the forum have been saying. No matter what you write Celia, it is true that the results have been amazing. Ask the parents of the kids who have had it done. VBS has found extreme success in the last few years. I do not undrstand your true opposition to it.

    That is NOT to say that VBS has not had its upsets too. Just like bracing...there are so many factors. Like, what degree curve a child has when they get the stapling or the brace? Where is the curve located? One curve or two? Compensatory or two individual curvatures? Stapling and bracing need to overcome the same obstacles.

    It would not be common to see a person greater than 45 degrees being stapled. Nor would it be common to recommend a brace at that time. Spinal fusion would most likely be the recommendation.

    I find it interesting that in the goat experiment you provide, Dr Braun et al, tethered those goats until there degree of curve was greater than 45 degrees. The average being 61 degrees?!!?... hello.... not a lot of wonderful outcomes will happen for that degree of curvature with stapling, spine cor, Scroth, boston, the hanging upside down thing, etc....

    Use spine cor before your curve hits 30 degrees and your likelihood of success has gone up tremendously. As Dr Rivard said to me on the phone a month or so ago. Guess what... the same is true for stapling. Try spine cor at 40 degrees... no promises there, not with stapling either. Scoliosis is frustrating that way.

    Vertebral stapling is absolutely an alternative to bracing. Spine cor or hard bracing or scroth or all the other stuff out there. Each person must research their options. One option will sit better with you depending on personal philosophy.

    Stephanie
    Last edited by stephanieC; 11-16-2007 at 08:33 PM.
    Mom to Michela ~age 12 ~VBS @ age 9 - 12/19/07 26* to 1*
    10/8/08 ~ curve is immeasurable!!
    07/16/09 ~ a few degrees overcorrected... being monitored
    12/28/09 ~ 14* overcorrected to the right
    2/23/10 ~ 12* overcorrected
    3/12/10 ~ Boston Brace at night to prevent further overcorrection. In brace corrects to -8*

  9. #9
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    Sorry, I wasn't aware you only wanted to hear me recount stories of clear sunny skies, summer afternoons by the lake and the pros of vertebral stapling. You should be aware that there are two sides to this picture before submitting your precious child to an elective experimental procedure that allows doctors to test theories with each new case for the benefit of future generations. Knowing what I read and hearing that some parents were getting the wrong impression about curves under 30 degrees not progressing, I could not with a clear conscience remain quiet. They even state in the article:

    Larger numbers of patients are needed to allow sub analysis of patients to decide who best benefits from stapling.
    Last edited by Celia; 11-17-2007 at 02:14 PM.

    Canadian eh
    Daughter, Deirdre born Oct 2000. Diagnosed with 60 degree curve at the age of 19 months. Serial casting by Dr. Hedden at Sick Kid's Hospital. Currently being treated by Dr. Rivard and Dr. Coillard in Montreal with the Spinecor brace and curve is holding at "2" degrees. Next appointment 2008

  10. #10
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    Celia,

    Sunny skies?? Afternoons by the lake?? Why all the sarcasm??

    I am perfectly aware of the "two sides of the picture" as you say. Parents are not given the wrong impression. You have a bizarre, over the top aversion to VBS. It is a viable option that parents should look into when faced with many years of bracing. That's all I am saying.

    I researched spine cor long and hard too. Nothing better about it. Just a different (and more ongoing) set of problems.

    As far as your article quote.. read it again...
    Larger numbers of patients are needed to allow sub analysis of patients to decide who best benefits from stapling. Hello..... this is true for spine cor too.

    It seems to me, that all methods of treating scoliosis work better in the smaller curves and/or younger children. No surprise there. Do your research!!

    I want parents to come on this forum and read all the information in a fair and balanced way. Then they should contact the Doctors(who are the actual experts) for a consult and learn more in depth what they need to know to make their decision regarding treatment.

    Stephanie
    Last edited by stephanieC; 11-17-2007 at 03:08 PM.
    Mom to Michela ~age 12 ~VBS @ age 9 - 12/19/07 26* to 1*
    10/8/08 ~ curve is immeasurable!!
    07/16/09 ~ a few degrees overcorrected... being monitored
    12/28/09 ~ 14* overcorrected to the right
    2/23/10 ~ 12* overcorrected
    3/12/10 ~ Boston Brace at night to prevent further overcorrection. In brace corrects to -8*

  11. #11
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    Mar 2004
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    I wish you all the best.

    Canadian eh
    Daughter, Deirdre born Oct 2000. Diagnosed with 60 degree curve at the age of 19 months. Serial casting by Dr. Hedden at Sick Kid's Hospital. Currently being treated by Dr. Rivard and Dr. Coillard in Montreal with the Spinecor brace and curve is holding at "2" degrees. Next appointment 2008

  12. #12
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    Oct 2007
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    Thank you Celia, I wish you and Deirdre all the best as well!!

    Stephanie
    Mom to Michela ~age 12 ~VBS @ age 9 - 12/19/07 26* to 1*
    10/8/08 ~ curve is immeasurable!!
    07/16/09 ~ a few degrees overcorrected... being monitored
    12/28/09 ~ 14* overcorrected to the right
    2/23/10 ~ 12* overcorrected
    3/12/10 ~ Boston Brace at night to prevent further overcorrection. In brace corrects to -8*

  13. #13
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    Jan 2006
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    Austin, Texas
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    Stepahnie,

    I apologize to you I should have warned you about Celia there is no reasoning with her ~ she has a very one sided opinion of VBS and truly just does not understand but I do have to admit she does a great job of doing a DISSERVICE by giving out prejudicial misinformation about VBS and an absolutely amazing job of SCARING parents who are merly asking questions to gain a better understanding of ALL available options to treating scoliosis.

    Please don't try to help her to understand the procedure because she won't. Maria and I have both tried and we really never wanted to change her opinion of the procedure because her opinion and her choices are her own but we did want her to at least consider how she approched new people all together because many times they are very fragile and her comments tend to scare them away but it was all just a HUGE waste of time as you can see ~ oh well ~ live and learn. I also believe Celia just has alot of anger issues that we here or on any support group can't help.

    On another note, you are 100% correct that VBS is already moving out of the experimental phase because it is now covered by insurance and the first VBS surgery covered by insurance will be perfomed by Dr. Hresko (Dr Betz is assisting) in Boston.

    Hugs to you and we'll talk more soon.

    ~A
    Amanda

    Mom to Lorena 7 yrs old
    Diagnosed 8/2005 ~ 26 Degree Curve
    Progressed to 42 Degrees by Dec 05
    Milwakee Brace 1/16/06 - 6/26/06
    Vertebral Stapling on 6/26/06 @ Shriners in Philadelphia
    26 Degree Post Op Curve
    Last X-Rays December 07 ~ 26 Degree Curve
    Email: domingo_amandapompa@msn.com
    Website: www.vertebralstapling.com
    YouTube Video: http://www.youtube.com/watch?v=n6GmX3K7FIs


  14. #14
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    I know you've made up your mind and that's okay! I realize these personal attacks stem from fear because hey who isn't scared ???? I'm not going to resort to mud flinging or name calling. My arguments so far on vertebral stapling deal with moral and ethical issues and I'm certain I have never slammed anyone for making this decision for their child. I was seriously contemplating it at one time if Deirdre ever progressed. If there is a message behind my posts to people considering this procedure it's this: *proceed with caution* Here is the abstract for the article I quoted above:

    1: Clin Orthop Relat Res. 2005 May;(434):55-60. FPRIVATE "TYPE=PICT;ALT=Click here to read" Links

    Vertebral body stapling procedure for the treatment of scoliosis in the growing child.

    Betz RR, D'Andrea LP, Mulcahey MJ, Chafetz RS.
    Shriners Hospitals for Children, Philadelphia, PA, USA. RandalBetz@aol.com
    Thirty-nine consecutive patients have had vertebral body stapling of 52 curves (26 patients with one curve stapled and 13 with two). For the group with patients who were 8 years or older with less than 50 degrees preoperative curve and a minimum 1-year followup, coronal curve stability was 87% when defined by progression less than or equal to 10 degrees . Fusion was necessary in two patients. No curves less than 30 degrees at the time of stapling progressed greater than or equal to 10 degrees . Major complications occurred in one patient (2.6%, diaphragmatic hernia) and minor complications occurred in five patients (13%). Further followup of the patient cohort and further research into efficacy and indications are warranted.
    PMID: 15864032 [PubMed - indexed for MEDLINE]
    Last edited by Celia; 11-20-2007 at 05:32 AM.

    Canadian eh
    Daughter, Deirdre born Oct 2000. Diagnosed with 60 degree curve at the age of 19 months. Serial casting by Dr. Hedden at Sick Kid's Hospital. Currently being treated by Dr. Rivard and Dr. Coillard in Montreal with the Spinecor brace and curve is holding at "2" degrees. Next appointment 2008

  15. #15
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    Celia,

    I have nothing further to say to you regarding vertebral stapling. I am curious, however, about why you felt the need to include the e-mail address of Dr. Betz in your post. What's the point?

    I read where you posted on another forum that the doctors performing the VS surgery were trying to "immortalize" themselves. Obviously another one of your cheap shots at Dr. Betz.

    Let me ask you...have you ever met the man?

    I've actually seen him in action dozens of times over the past four years at Shriners. I don't think I've ever met a more caring and compassionate doctor. Other parents of his patients have used the words "humble", "unassuming", "down-to-earth" to describe him. Their words, not mine. His colleagues, many of whom I have gotten to know over the years, also admire how he goes about his work and how he truly cares about helping kids. I can't tell you how many parents I have met while in the waiting room at Shriners who told me that he helped their child when nobody else knew what to do for them. He's clearly one of the best pediatric orthopedic surgeons around - even YOUR own beloved doctor in Montreal recommened Dr. Betz to a patient.

    But you have decided he is trying to immortalize himself. You, who just told Amanda you don't want to sling any mud.

    Rest assured, the LAST thing in the world Dr. Betz cares about is immortalizing himself. He's the first one to turn the spotlight or credit to one of his staff members, and away from himself.

    In the past you have accused Amanda and I of having a vested interest in recruiting patients for Dr. Betz (equally ridiculous). In fact, it would be as ridiculous as us accusing YOU of having a vested interest in recruiting patients for your Spinecor doctors in Montreal - or for doctors who do serial casting. But Amanda and I are RATIONAL, so we choose not to do that. Obviously, you are happy with the care these doctors provided to your daughter and you would therefore suggest that other intelligent, educated parents CONSIDER those options. That's fine.

    But why isn't it OK if we do the same thing?

    I saw with my own eyes on David's last x-ray not only how his curve has improved but his rotation as well. Would I prefer that he did not have to have the stapling? Of course I would. Would I choose the stapling again over the other available options? IN A HEARTBEAT.
    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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