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Thread: Recent study on VBS published in Spine

  1. #1
    Join Date
    Jan 2008

    Recent study on VBS published in Spine

    Vertebral Body Stapling for Moderate Juvenile and Early Adolescent Idiopathic Scoliosis: Cautions and Patient Selection Criteria
    Bumpass, David B.; Fuhrhop, Sara K.; Schootman, Mario; More

    Study Design. Single-surgeon retrospective case series.

    Objective. To validate and further describe clinical and radiographic outcomes of patients undergoing vertebral body stapling (VBS), with the goal of learning if VBS is a safe and effective alternative to bracing for treating moderate idiopathic scoliosis (IS) in the growing pediatric patient.

    Summary of Background Data. VBS is a growth-modulation technique to control moderate idiopathic scoliosis (IS) while avoiding fusion. Existing studies state successful curve control rates equivalent to bracing, but the majority of reports have come from a single institution.

    Methods. All IS patients who underwent VBS by 1 surgeon were included. Indications were brace intolerance and a structural coronal curve of 25° to 40°. Proportional nitinol staples were used in all cases. Pre- and postoperative radiographs, pulmonary function testing, and physical exam measurements were serially recorded.

    Results. VBS was performed on 35 patients (28 females, 7 males) with mean age 10.5 years (range 7.0–14.6 years). Total of 31 patients (33 stapled curves) completed follow-up. Preoperative Risser grade was 0 in 31 patients, 1 in 1 patient, and 2 in 3 patients. Stapled curves were controlled with <10° of progression in 61% of cases. Curves <35° had a control rate of 75%, and patients <10 years had a 62% curve control rate. Eleven patients (31%) required subsequent fusions; two curves (6%) over-corrected. Preoperative supine flexibility > 30% was predictive of ultimate curve control. No neurologic complications were encountered; 5 patients (14%) developed small pneumothoraces.

    Conclusion. This series contains the most patients and longest followup reported for VBS. Successful curve control was achieved less frequently than in previous reports, particularly in patients <10 years.

    Level of Evidence: 4
    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."

  2. #2
    Join Date
    Aug 2004
    I don't recognize any of the names mentioned in the study. That said, it's not too far off other studies I've seen. For example, curves 35 degrees or less respond best to VBS (75-80% success rate). Other factors to consider is curve flexibility upon bending x-ray prior to surgery.

    Another thing to consider is that with the emergence of VBT (tethering), curves that present at 35 degrees or more can usually achieve better success with VBT.

    In fact, for anyone who is interested in following the changes in the use of tethering, it is now not unusual for surgeons to tether curves even in the 50s and 60s (there may have even been a case or two over 70 degrees). A lot has to do with how flexible the curve is, among other things but a curve of, say, 60 or even 65 degrees is no longer an automatic deal breaker.

    Also, there are now three groups of surgeons who I am aware of (Drs. Antonacci/Betz in NYC, Dr. Braun in MA, and Dr. Dan Hornshmeyer (sp?) in MO) who will accept skeletally mature patients for VBT. In fact, Drs. Antonacci/Betz performed VBT on a 50-year old woman recently.

    I have added a link to my signature to the FB page focusing solely on this which is called 'Scoliosis Tethering (VBT) Support'.
    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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