Vertebral Body Stapling

Vertebral Body Stapling (VBS) Part 2

1.  What is the success rate for VBS?  Two centers have reported their outcomes of
VBS in patients (Washington University in St. Louis, and the Philadelphia
  Overall success rates for
lumbar and thoracic curves are around 70%, which means the curve improved, did
not change or changed less than 6 degrees.
2.  What is the success rate of bracing?  The highest level of evidence on bracing for
idiopathic scoliosis is from the BRIAST study, which was a prospective study of
scoliosis patients who wore a scoliosis brace and those who did not.
  48% of non-braced patients did not have
progression of their scoliosis and 72% of braced patients did not progress.
3.  So to conclude: the success rates for VBS and
bracing appear to be equivalent.
4.  Why would a VBS be offered or performed if the
results are similar to bracing?
is not an easy treatment for anyone.
provides an option for those patients who cannot or will not wear a brace to control
their scoliosis.
  It is important to note
VBS is not better than bracing, it is just a different treatment option.
5. Do the staples have to be removed in the
  The answer is no.  The staples do not have to be removed.  The body will cover over the staple with scar
tissue and the staple will gradually loosen in the vertebral body.
  Due to the tines of the staple curving in the
staples will not back out.
6.  What happens if the VBS does not control the
scoliosis and a posterior spinal fusion is needed? Do the staples have to be
removed at that time?
  Again, no.  Since the staples are placed in the front of
the spine they will not interfere with the instrumentation placed in the
posterior (back) part of the spine.
the staples do not interfere with the ability to correct the scoliosis at the
time of fusion.
7.  Who is a candidate for Vertebral Body Stapling?
     a.  Skeletally immature: since scoliosis mainly
progresses due to growth, the use of VBS only is indicated during the growth.
  There is no benefit of VBS in skeletally
mature individuals
     b.   Scoliosis who Cobb measure is:

35 degrees in the thoracic spine

40 degrees in the lumbar spine
     c.  Patients who cannot or will not wear a brace to
halt the progression of scoliosis.
     d.  Diagnosis of idiopathic scoliosis or patients
who have idiopathic-like scoliosis
Who is not a candidate for VBS?
Skeletally mature patients: Risser >/=3
Diagnoses with poor bone quality, increased
muscular tone, neurogenic scoliosis (patients with Chiari or syrinx), etc…
Cobb measures >35 in the thoracic spine and
>40 in the lumbar spine.
Increased kyphosis of the thoracic spine >40
degrees (since the staples induce kyphosis)
Those patients whose spine is excessively
malrotated due to the scoliosis.  VBS
will not significantly change this for the better.

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