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Anterior Growth Modulation Techniques: Vertebral Body Stapling

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The Growing Spine

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Abstract

Vertebral body stapling (VBS) is a fusionless treatment alternative to observation and bracing for the growing child with moderate (20–45°) idiopathic scoliosis. Thoracic spine staples are inserted thoracoscopically, and thoracolumbar or lumbar staples are placed through a minimal access direct lateral retroperitoneal approach.

The following indications and strategies are recommended for stapling:

  • Age: less than 13 years in female and less than 15 years in males.

  • Growth remaining: Risser 0–2; at least 1 year of remaining growth on wrist radiographs; and Sanders digital stage less than or equal to 4.

  • Thoracic and lumbar coronal curve less than 45° with minimal rotation and flexible with side bending correction to less than 20°.

  • Sagittal thoracic kyphosis less than 40°.

  • Consider adding a posterior rib to the spine growing rod or VEPTR construct during the stapling procedure if the thoracic curve measures 35–45° and does not bend below 20°.

  • Postoperative nighttime bracing should be used if the curve on the first erect film does not measure less than 20°.

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Author information

Authors and Affiliations

  1. Section of Orthopaedic Surgery, Children’s Hospital of Philadelphia, 34th St & Civic Center Blvd, Philadelphia, PA, 19104, USA

    Patrick J. Cahill MD

  2. Department of Orthopedic Surgery and Sports Medicine, Temple University Hospital, Philadelphia, PA, USA

    Justin Iorio MD

  3. Department of Neurosurgery, Shriners Hospitals for Children-Philadelphia, 3551 North Broad Street, Philadelphia, PA, 19140, USA

    Amer F. Samdani MD

  4. Shriners Hospitals for Children, 34th St and Civic Center Blvd, Philadelphia, PA, 19104, USA

    Joshua M. Pahys MD

  5. Institute for Spine and Scoliosis, Lawrenceville, NJ, USA

    Randal R. Betz MD

Authors
  1. Patrick J. Cahill MD
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  2. Justin Iorio MD
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  3. Amer F. Samdani MD
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  4. Joshua M. Pahys MD
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  5. Randal R. Betz MD
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Corresponding author

Correspondence to Patrick J. Cahill MD .

Editor information

Editors and Affiliations

  1. San Diego Center for Spinal Disorders Medical Group, Inc., La Jolla, California, USA

    Behrooz A. Akbarnia

  2. Hacettepe University Dept. Orthopedics & Traumatology, Sihhiye, Ankara, Turkey

    Muharrem Yazici

  3. Rainbow Babies & Children's Hospital, Cleveland, Ohio, USA

    George H. Thompson

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Cahill, P.J., Iorio, J., Samdani, A.F., Pahys, J.M., Betz, R.R. (2016). Anterior Growth Modulation Techniques: Vertebral Body Stapling. In: Akbarnia, B., Yazici, M., Thompson, G. (eds) The Growing Spine. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-48284-1_43

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  • DOI: https://doi.org/10.1007/978-3-662-48284-1_43

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-48283-4

  • Online ISBN: 978-3-662-48284-1

  • eBook Packages: MedicineMedicine (R0)

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