• Alexander A Theologis, Patrick Cahill, Mike Auriemma, Randal Betz, and Mohammad Diab.
• *Department of Orthopaedic Surgery, University of California at San Francisco, San Francisco, CA; and †Department of Orthopaedic Surgery, Shriners Hospitals for Children, Philadelphia, PA.
• Spine. 2013 Dec 1;38(25):E1583-8.

Study DesignDual-center, retrospective study.ObjectiveTo 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 DataPatients 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.MethodsPatients 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.ResultsTwelve 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.ConclusionVBS 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.

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