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Review of Staple Use in Curve Correction for Idiopathic Scoliosis

» Review of Staple Use in Curve Correction for Idiopathic Scoliosis
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Physiotherapy in Calgary for Mid Back

This article will be of interest to you as it reviews the use of vertebral body stapling to correct this curvature.

Idiopathic scoliosis, curvature of the spine for unknown reasons, may be treated in a few ways. While mild curves may be left untouched but monitored, moderate curves of between 20 to 45 degrees may be treated by bracing, sometimes for up to 23 hours per day. However, not all doctors agree with bracing as treatment and feel that surgery is a more effective and permanent solution for the curved spine. This opinion is often due to factors such as teen patients not being compliant with their bracing treatment, often because the braces result in poor self-image, particularly in boys.

Surgery can be approached in a number of ways. One method involves using staples across the length of the bones, the physes, but earlier attempts at using staples were not very successful, resulting in problems such as breaking or loosening, causing instability in the spine. The authors of this study reviewed the cases of patients who had undergone stapling with a new product. The goal of the study was to see if the new product was feasible and safe, two years after surgery.

Researchers reviewed the cases of 28 patients (24 girls) who had been treated with vertebral body stapling. Among the patients, there were 26 thoracic (mid back) curves and 15 lumbar (lower back) curves. The study began with 29 patients, but one was lost to follow up after one year. The researchers noted the patients' age at the time of surgery (average 9.4 years), the procedure, when the surgery occurred, if any complications occurred, the patients' measurements before and after surgery, after one year and again after two, as well as x-rays taken every three months.

All the patients underwent the same type of surgery and the same type of postoperative car. They initially wore a non-corrective brace (corset) that was used to stabilize the staples. After four weeks, the patients were allowed "activity as tolerated," and after six weeks, the patients had no activity restrictions. To be considered a successful outcome from surgery, the patients' curves were corrected to within 10 degrees of surgery measurements or had decreased more than 10 degrees.

When reviewing the findings, the researchers noted that in 13 patients, only the thoracic curve was stapled, while 13 patients had both thoracic and lumbar curves stapled. Finally, two patients had only lumbar curves stapled.

The thoracic group curves were divided into two, depending on their curve size: below 35 degrees and 35 degrees or more. Among the 18 curves of less than 35 degrees, three improved, there was no change in 11 and four worsened. There were eight curves in the other group. Only one improved, there was no change in one, and six worsened. Thoracic kyphosis, humpback, improved in seven patients.

The lumbar curves (15) were kept in one group. Three patients with lumbar curves improved, 10 had no change, and two worsened. Lumbar lordosis, swayback, improved in all cases.

Patients who had both curves (13) showed a 61 percent rate of success, but the authors noted that the group was too small to see if there were any significant differences in the changes between the double curves and the single ones in the other patients.

Complications did occur as a result of some of the procedures. In this group, there were two major complications (rupture of a congenital diaphragmatic hernia after surgery, and an overcorrection of the curve, making it necessary for a second surgery to reverse the curve). There were two minor complications and three broken staples but none of them needed to be removed.

The authors concluded that the stapling could be an option to treat scoliosis that could still progress but more follow up, particularly as the patients head towards bone maturity, is needed to be more definite.

Reference: Randal R. Betz, MD, et al. Vertebral Body Stapling. In Spine. January 15, 2010. Vol. 35, No. 2. Pp. 169-176.

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