Interesting Study . . .

[Joe's Mom]

This was posted on another Scoliosis Site and I thought the study was very interesting. AH Crawford is a doctor who saw my son when he was initially diagnosed and described to me as a "specialist" in scoliosis.


Spine. 2005 May 15;30(10):1148-53. Related Articles, Links


Endoscopic mechanical spinal hemiepiphysiodesis modifies spine growth.

Wall EJ, Bylski-Austrow DI, Kolata RJ, Crawford AH.

Children's Hospital Medical Center and The University of Cincinnati
College of Medicine, Cincinnati, Ohio, USA.

STUDY DESIGN: An in vivo porcine model of progressive scoliosis as an
inverse analog of a proposed method of early surgical treatment.
OBJECTIVES: To test the hypothesis that scoliotic curvatures may be
repeatedly created using anatomically based vertebral staples and
thoracoscopic surgical procedures. SUMMARY OF BACKGROUND DATA: Staple
hemiepiphysiodesis is an established method for treating knee
deformities. Similar procedures have so far failed to arrest or
correct deformities of the spine. While experimental studies continue
to suggest that spine growth is modifiable, no prior clinically
translatable method has been shown to clearly and consistently alter
vertebral growth. METHODS: Custom spine staples were implanted into
midthoracic vertebrae of seven skeletally immature normal pigs. Each
staple spanned an intervertebral disc and two growth plates and was
fixed to adjacent vertebrae with screws. The animals were
anesthetized biweekly for radiography during the 8-week study period.
Final radiographs were taken after spine harvest. Initial and final
postoperative Cobb angles were compared statistically. RESULTS: Five
animals completed the protocol with a weight increase of 142% in 8
weeks. Coronal plane curvatures increased significantly with time,
from 0.8 (+/-1.8) to 22.4 (+/-2.8; P = 0.0001). On average, sagittal
plane curvatures did not increase with time. CONCLUSIONS: Spinal
hemiepiphysiodesis using an anatomically based implant and minimally
invasive procedures repeatedly induced spine curvature in a normal
porcine model. These techniques may slow, and perhaps even correct,
early progressive spine deformity without long rod instrumentation or
fusion.

[LindaRacine]

Here's an update on the Shriners Philadelphia study on using vertebral body staples instead of an external brace:

http://www.ncbi.nlm.nih.gov/entrez/q...032&query_hl=1

[Carmell]

Both of these hospitals are also FDA (HDE) approved VEPTR/Titanium Rib sites. These docs have their hands in several new/newer procedures to give scoliosis patients other options than the traditional fusion option.

[Celia]

Joe's Mom,

It was me who posted that I wanted to know if this procedure was already being performed on children.

Linda,

I don't think Vertebral Body Stapling and Endoscopic Mechanical Spinal Hemiepiphysiodesis is the same procedure.




Celia

[LindaRacine]

Celia...

It's definitely not the same procedure, but I believe they're looking for the same result. The Cincinnati study was performed on pigs, so I certainly wouldn't want my child to be one of the first humans if the Philadelphia technique would be possible. (Actually, I don't think I'd want my kid going through either procedure unless there was a problem with them wearing a brace.)

Regards,
Linda

[Celia]

Linda,

I was under the impression that doctors who conducted the study were looking at Endoscopic Mechanical Spinal Hemiepiphysiodesis as an alternative to spinal fusion rather than as an alternative to bracing. It's my understanding that many doctor regard spinal fusion as less than ideal for progressive scoliosis in very young spines. The Titanium Rib - which is now hailed as a life saving device - was not even tested on animals. The major drawback to the Titanium Rib is repeated surgeries every six months until maturation. It looks as though two major advantages ( aside from the fact that it is a new procedure and is in the testing stages ) to Endoscopic Mechanical Spinal Hemiepiphysiodesis is that there is only one surgery and it doesn't involve fusion.



Regards,


Celia

[LindaRacine]

Hi Celia...

It was this text:

These techniques may slow, and perhaps even correct,
early progressive spine deformity without long rod instrumentation or
fusion.

that may be think that it's an alternative to bracing, but you may be right. One would need to see the entire paper to know for sure. I'll probably see Dr. Crawford in July, and will be sure to talk to him about it.

Regards,
Linda