Wednesday, March 21, 2018

Vertebral Body Stapling (VBS)      Part 1

  1. What is Vertebral Body Stapling?  How is it different from Vertebral Body Tethers?  In a previous blog the surgical technique of Vertebral Body Tethering was presented.  This technique places a compressive force over the convex side of the spine (slowing down growth), to permit the concave side of the spine to relatively grow more and create a straighter spine.  Prior to the introduction of the Vertebral Body Tether, which uses screws placed into the vertebral body, modulating growth of the concave and convex side of the spine was accomplished with staples.  These staples were also placed anteriorly, but instead of being placed in the middle of the vertebral body they were placed across the disc spaces between each vertebral body. 

  1. Is VBS a new procedure? This surgical technique was first reported in the 1950s but, due to the lack of an adequate implant, the technique did not work as designed.  It wasn’t until the 2000s that an appropriate implant was identified, and this technique began to show promise.  The staples used at that time, and currently, are made of Nitinol which is a memory-shape alloy.  When the staples are placed in an ice bath, the tines of the staples can be straightened.  After placement across the disc space the staple warms up to body temperature and the tines curve back inward.
  2. What is the purpose of VBS?  To halt or improve scoliosis in the skeletally immature patient.
  3. What research has been done on VBS?  There have been animal studies and clinical studies over the last 15 years.
  4. Are there any potential complications of VBS? As with any surgical procedure there can be complications related to the surgical procedure or the patient’s underlying medical condition.  The potential complications includes, but is not limited to:
    1. Anesthetic (anaphylaxis, airway, etc…)
    2. Pneumothorax
    3. Excessive bleeding
    4. For thoracic stapling: Injury to the lung, heart, great vessels, thoracic duct, etc…
    5. For lumbar stapling: injury to the great vessels, ureter, psoas dysfunction, etc…
    6. Painful postoperative surgical scar
    7. Staple dislodgement
    8. Staple breakage
    9. Failure to control the scoliosis
    10. Need for definitive spinal fusion

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