Convex hemiepiphysiodesis: the limits of vertebral stapling

We performed a retrospective chart review of patients with nonadolescent idiopathic scoliosis who underwent open vertebral stapling for treatment of spinal deformity. The objective of this study was to determine the efficacy of vertebral stapling in patients with scoliosis. Measurements included initial deformity correction and maintenance of correction. Growth modulation has become a topic of interest recently in the spinal deformity literature. It refers to the tethering of growth on one side of the spine to allow for compensatory growth on the contralateral side, and, in theory, correction of scoliosis. Recent studies on endoscopic vertebral stapling have shown promising early results in adolescents with idiopathic scoliosis. Little is known about its applicability in patients with more "malignant" types of scoliosis. The medical records and radiographs of 11 children who underwent open vertebral stapling between June 2003 and August 2004 were reviewed. Patients with adolescent idiopathic scoliosis (AIS) were excluded. RESULTS.: Diagnoses included myelodysplasia, congenital scoliosis, juvenile, and infantile idiopathic scoliosis, Marfan syndrome, paralytic scoliosis, and neuromuscular scoliosis. The average age at surgery was 6 + 11 year. All patients were skeletally immature. Preoperative curves averaged 68° (22°-105°). Of the 11, six thoracic curves and five thoracolumbar curves were stapled. Four patients had minor curves, which were not stapled. Initial postoperative radiographs averaged 45° (24°-88°). Average follow-up was 22 month for our series (16-28 month). At final follow-up, scoliosis averaged 69° (36°-107°). Five of the 11 patients have subsequently undergone secondary surgical procedures for progression of scoliosis, including growing rod insertion in three, combined anterior/posterior spinal fusion in another, and bilateral vertical expandable prosthetic titanium rib insertion in a patient with myelodysplasia. Three of the remaining six patients are scheduled for secondary surgery. More than half of the patients in our series have undergone or are scheduled to undergo further spinal surgery, at an average of 2 year after anterior vertebral stapling. It is unclear if progression may be related to the young age at surgery, the relatively severe average preoperative curve magnitude, the nature of the underlying scoliosis, or a combination of these.