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Vertebral growth modulation (or vertebral stapling) is a novel surgical technique that may prevent spinal curve progression in children and adolescents diagnosed with moderate scoliosis.
A minimally invasive procedure, stapling may be an alternative to bracing for some patients who are at risk for progression of the scoliosis and the prospect of spinal fusion in their future. Surgeons, through the aid of an endoscopic camera, insert special staples, made of titanium alloy, along the outer curve of the spine to help stabilize and prevent further progression of the curve.
Ideal candidates for this procedure are children and adolescents between 8-15 years old, who have not reached skeletal maturity and are seeking an alternative to wearing a spinal brace. The child should have a moderate spinal curve, between 25-40°, and present a risk for curve progression. Patients should have no major kyphosis (forward curve in the upper spine).
Benefits of this minimally invasive procedure over more traditional surgical methods (open surgery), such as spinal fusion, include the use of fewer and smaller incisions. This relatively new approach allows the child to recuperate faster and with less pain. Vertebral stapling also eliminates the need for a spinal brace, which may allow children and adolescents to participate more actively in sports and other activities.
In addition, the stapling procedure maintains some of the natural spine motion, which is lost during the spinal fusion procedure.
Vertebral stapling is not an ideal procedure for all children. Children or adolescents who have reached skeletal maturity, or those with stiff or large spinal curves, will not benefit from this procedure. Further surgery may be needed if vertebral stapling is not successful in stopping the progression of the spinal curve. As with other innovative surgical procedures, there is a limited amount of clinical data available. The long-term outcome for this procedure is unknown. Vertebral stapling is a novel procedure that may not be covered by insurance.
Recent advancements in technology have led to the development of staples that are made from nitinol—a shaped memory alloy. Comprised of nickel and titanium, these staples are pliable when exposed to cooler temperatures. This special material allows the staples to hold one shape when cool and another shape when warm (figure 1).
By placing the staples in an ice tray prior to insertion (figure 2), the surgeon is able to straighten the staple—making it easier to insert along the spinal curve. When warmed by body temperature, the staples return to their original crimped shape.
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