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Vertebral Body Stapling (VBS) vs. Bracing for Patients with High‐Risk Moderate Idiopathic Scoliosis (IS): Paper #3

Cuddihy, Laury MD; Danielsson, Aina J. MD, PhD; Cahill, Patrick J. MD; Richmond, John MD; Samdani, Amer F. MD; Mulcahey, Mary Jane PhD; Betz, Randal R. MD

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United States

Summary: This is a retrospective comparison study of vertebral body stapling (VBS) versus bracing for patients with moderate idiopathic scoliosis (IS) (25‐44°) using identical inclusion criteria. The results of treatment of thoracic curves measuring 25‐34° and all lumbar curves, whether by VBS or bracing, appear to be similar. For thoracic curves 35‐44°, the results were worst with stapling, which has led to alternative fusionless surgery strategies.

Introduction: We retrospectively compared VBS versus bracing for patients with moderate IS to determine which is more effective at maintaining or improving curve magnitude.

Methods: Inclusion Criteria: 1) Diagnosis of idiopathic scoliosis; 2) age ≥8 years 3) curve 25‐44°; 4) Risser 0 or 1; 5) minimum 2‐year follow‐up. The VBS cohort was derived from a retrospective IRB‐approved analysis of a consecutive series of 160 patients of which 49 met the inclusion criteria. 43 of the 49 (88%) were available for follow‐up. The bracing cohort (N=165) was derived from a bracing database from Sweden. “Improvement” was defined as improvement in the pre‐treatment Cobb angle of > 10°. “No change” was defined as +10° to −10° change, inclusive. “Progression” was defined as worsening of the curve > 10°.

Results: The average age at initiation of treatment of the VBS group vs. the bracing group was 10.5 yrs vs. 12.7 yrs. Average curve size was 31 vs. 32° and average follow‐up was 41 vs. 43 months. For thoracic curves 25‐34°, VBS had a success rate of 80% versus 64% for bracing. In thoracic curves 35‐44°, VBS and bracing had success rates of 18% and 57%, respectively. For lumbar curves 25‐34°, VBS had a 79% success rate versus 69% for bracing. For lumbar curves 35‐44°, VBS had a 60% success rate versus 60% for bracing (Table 1).

Conclusion: In this comparison, the results for treatment of smaller thoracic curves (<35°) and all lumbar curves appear to be similar for both VBS and bracing, suggesting that VBS could be used as an alternative to bracing. For thoracic curves 35‐44°, the results were poor with stapling, which has led to alternative fusionless strategies.

The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an ‘off label’ use).

© 2010 Lippincott Williams & Wilkins, Inc.

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