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Vertebral Body Stapling in Children Younger Than 10 Years With Idiopathic Scoliosis With Curve Magnitude of 30° to 39°

Theologis, Alexander A. MD*; Cahill, Patrick MD; Auriemma, Mike BS; Betz, Randal MD; Diab, Mohammad MD*

doi: 10.1097/BRS.0b013e3182a8280d
Deformity

Study Design. Dual-center, retrospective study.

Objective. To evaluate whether vertebral body stapling (VBS) influences curve progression between 30° and 39° in children younger than 10 years with idiopathic scoliosis.

Summary of Background Data. Patients younger than 10 years with idiopathic scoliosis of more than 30° have a 100% risk of progression to spine fusion regardless of nonoperative treatment. VBS may represent an alternative fusionless treatment option for this group of high-risk patients.

Methods. Patients younger than 10 years with idiopathic thoracic or lumbar scoliosis of 30° to 39° 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 a need for reoperation. Preoperative and postoperative curve magnitudes were compared using a paired Student t test. Postoperative curve magnitudes were compared with one another using a paired Student t test. A P value of less than 0.05 was defined as statistically significant.

Results. Twelve patients were studied (female: n = 12; average age: 7.8 yr [range: 6.3–9.7 yr]). Thirteen curves were treated with VBS (thoracic: n = 9; lumbar: n = 4). The average follow-up was 3.4 years (range: 2.2–5.4 yr). The average preoperative curve magnitude was 33.4° (range: 30°–39°). The immediate postoperative curve magnitude (19.0°; range: 0°–29°) and curve magnitude at the most recent follow-up (23.0°; range: 10°–34°) were significantly less than the preoperative magnitude of 33.4°. Both thoracic curves (100%) and lumbar curves (100%) were treated successfully. Curve magnitudes did not change significantly postoperatively between the first erect radiographs and the most recent follow-up. Two patients had pneumothorax, and 1 patient had symptomatic pleural effusion. No patient required definitive fusion for curve progression.

Conclusion. VBS is effective in controlling curve progression in the high-risk group of children younger than 10 years with idiopathic scoliosis between 30° and 39° in whom bracing may be ineffective.

Level of Evidence: 4

In a dual-center, retrospective study of 12 children with idiopathic scoliosis between 30° and 39° treated with vertebral body stapling, 100% of the children were treated successfully without complication or a need for definitive fusion for curve progression.

*Department of Orthopaedic Surgery, University of California at San Francisco, San Francisco, CA; and

Department of Orthopaedic Surgery, Shriners Hospitals for Children, Philadelphia, PA.

Address correspondence and reprint requests to Alexander A. Theologis, MD, Department of Orthopaedic Surgery, University of California at San Francisco, 400 Parnassus Ave., San Francisco, CA 94143; E-mail: Alekos.Theologis@ucsf.edu

Acknowledgment date: February 4, 2013. First Revision date: July 8, 2013. Acceptance date: August 2, 2013.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: board membership, consultancy, payment for lectures, grants/grants pending, royalties, stock/stock options, and travel/accommodations/meeting expenses.

© 2013 by Lippincott Williams & Wilkins