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Displaying items by tag: VBS and scoliosis
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Anterior vertebral body stapling is a new minimally invasive technique to correct scoliotic deformities without fusion. In the literature only preliminary reports with short follow-up periods are available. A total of six patients with a minimum follow-up of 2 years were available for examination.
Of the six patients, four demonstrated progression of scoliosis in spite of vertebral body stapling. All had curves of more than 35 degrees at the time of surgery, while two patients with less extensive curves below 35 degrees did not show signs of progression. Major complications were not observed. Vertebral body stapling for curves more than 35 degrees does not seem to be indicated and careful patient selection for stapling may be indicated for curves less than 35 degrees. A more general use of this technique is not recommended at this time.
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*** Note, VBS is generally is NOT indicated for adolescent idiopathic scoliosis due to lack of suffient spinal growth potential past the age of 12 years old.
STUDY DESIGN: Retrospective review.
OBJECTIVE: To report the results of vertebral body stapling (VBS) with minimum 2-year follow-up in patients with idiopathic scoliosis.
SUMMARY OF BACKGROUND DATA: While bracing for idiopathic scoliosis is moderately successful, its efficacy has been called into question, and it carries associated psychosocial ramifications. VBS has been shown to be a safe, feasible alternative to bracing for idiopathic scoliosis.
METHODS: We retrospectively reviewed 28 of 29 patients (96%) with idiopathic scoliosis treated with VBS followed for a minimum of 2 years. Inclusion criteria: Risser sign of 0 or 1 and coronal curve measuring between 20 degrees and 45 degrees .
RESULTS: There were 26 thoracic and 15 lumbar curves. Average follow-up was 3.2 years. The procedure was considered a success if curves corrected to within 10 degrees of preoperative measurement or decreased >10 degrees . Thoracic curves measuring <35 degrees had a success rate of 77.7%. Curves which reached < or =20 degrees on first erect radiograph had a success rate of 85.7%. Flexible curves >50% correction on bend film had a success rate of 71.4%. Of the 26 curves, 4 (15%) showed correction >10 degrees. Kyphosis improved in 7 patients with preoperative hypokyphosis (<10 degrees of kyphosis T5-T12). Of the patients, 83.5% had remaining normal thoracic kyphosis of 10 degrees to 40 degrees. Lumbar curves demonstrated a success rate of 86.7%. Four of the 15 lumbar curves (27%) showed correction >10 degrees. Major complications include rupture of a unrecognized congenital diaphragmatic hernia and curve overcorrection in 1 patient. Two minor complications included superior mesenteric artery syndrome and atelectasis due to a mucous plug. There were no instances of staple dislodgement or neurovascular injury.
CONCLUSION: Analysis of patients with idiopathic scoliosis (IS) with high-risk progression treated with vertebral body stapling (VBS) and minimum 2-year follow-up shows a success rate of 87% in all lumbar curves and in 79% of thoracic curves <35 degrees. Thoracic curves >35 degrees were not successful and require alternative treatments.
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