Charles Wang, MD; Shaleen Vira, MD; and Peter G. Passias, MD, comment on Cahill PJ, Auriemma M, Dakwar E, Gaughan JP, Samdani AF, Pahys JM, Betz RR. Factors predictive of outcomes in vertebral body stapling for idiopathic scoliosis. Spine Deformity. 2017 Mar;6:28-37.
The current management of moderate adolescent idiopathic scoliosis (AIS) is conservative and includes observation and thoracolumbosacral orthosis (TLSO) bracing. However, this method is not completely efficacious and requires a less-invasive next step in management to prevent progression of the deformity to the point of requiring spinal fusion surgery.
Vertebral body stapling (VBS) is a relatively new treatment modality that has demonstrated successful initial outcomes. In a recent retrospective review, Cahill et al sought to identify which immature patients are the optimal candidates for VBS.
In this study, 63 patients were retrospectively reviewed, with a mean follow-up of 3.62 years. Average patient age was 10.8 years. The average curve magnitude was 29.5 thoracic and 31.1 lumbar. Success was defined as avoidance of progression and/or fusion. Failure was defined as an increase of follow-up radiograph curves by greater than 10.
VBS was shown to have a success rate of 74% in the treatment of thoracic curves and an 82% success rate in the treatment of lumbar curves.
Variables that were strongly associated with successful outcomes included amount of correction obtained at surgery and the preoperative flexibility in lumbar curves.Complications included staple movement/loosening (1%), localized sympathetic dysfunction (0.5%), atelectasis (0.5%), and superior mesenteric artery syndrome (0.5%).
Patients classified as having moderate AIS are at an increased risk for curvature progression, especially in Risser 0 and 1 patients. These patients are at an inevitable high risk for requiring spinal fusion.
To help them avoid spinal fusion, an intermediate treatment option with less invasiveness is required. Recent studies have affirmed the successful findings reported by Cahill et al.
Patients who may benefit more from undergoing VBS were identified in this study. First erect Cobb magnitude and preoperative curve flexibility are characteristics strongly associated with success and failure rates of VBS. Applying these variables in the preoperative workup of moderate AIS patients can help improve outcomes and decrease complication rates in the treatment of this condition.
The findings of this study can aid orthopedic surgeons in risk-stratifying their patients and can help in patient-physician discussions regarding treatment options.
Peter G. Passias, MD, is an Associate Professor of Orthopaedic Surgery, Division of Spine Surgery, at NYU Langone Health – NYU Langone Orthopaedic Hospital, New York, NY. Charles Wang, MD, and Shaleen Vira, MD, are resident physicians at NYU Langone Health – NYU Langone Orthopaedic Hospital, New York, NY.
The authors have no disclosures relevant to this article.
This article was originally published as Vertebral Body Stapling: A Novel Treatment of Moderate Idiopathic Scoliosis in the NYU Langone Orthopedics Journal Watch section of www.ICJR.net. Republished with permission.