New stapling treatment may help reverse scoliosis

Dec 1 2008

Morgan Stanley Children's Hospital of NewYork-Presbyterian is one of only a few hospitals in the country to offer spinal stapling, a new treatment alternative for young people with scoliosis, an abnormal curvature of the spine that is painful and can restrict breathing.

The Center for Early Onset Scoliosis, led by Dr Michael Vitale, sees about 400 patients per year under the age of 5 with the condition. Spinal stapling is one of a number of new techniques that promise improved outcomes.

Tens of thousands of children in the U.S. are diagnosed with scoliosis each year. When the curvature is moderate, spinal braces can be used to slow or decrease the chance of progression. Until now, however, there was no way to reverse progression and straighten the spine.

Spinal stapling is a two-hour minimally invasive surgery that involves implanting inch-long metallic staples across the growth plates of the spine. Made of a high-tech temperature-sensitive metal alloy, the staples are implanted using a camera called a thoracoscope with a very limited incision and minimal scar. The procedure is available to children with progressive moderate scoliosis (less than 30°) who are still growing (girls up to age 14 and boys up to age 16).

"Stapling not only stops scoliosis from getting worse, but can even correct the curve," says Dr. Michael Vitale, chief of pediatric spine and scoliosis surgery at Morgan Stanley Children's Hospital of NewYork-Presbyterian and the Ana Lucia Associate Professor of Clinical Pediatrics and Orthopaedic Surgery at Columbia University College of Physicians and Surgeons. "While most children do well with spinal fusion, we are on the cusp of a new era in the treatment of scoliosis. For the first time, we have a way to potentially reverse the scoliosis. "

Braces can be uncomfortable and embarrassing for children, notes Dr. Vitale. The custom-made plastic corset is usually worn all but one or two hours a day, and its tight fit presses against the stomach, making eating and any sports difficult.

Spinal fusion, too, has its drawbacks. "We recently presented evidence that spinal fusion in young children can lead to significant issues in quality of life and pulmonary function over the long term," says Dr. Vitale, who presented the findings at the International Conference on Early Onset Scoliosis in Montreal. The study followed 27 patients who received spinal fusion, which permanently connects several vertebrae. After 10 years, their pulmonary function, measured by lung volume, and reported quality of life were significantly less than that of a healthy child.

"While stapling is very new," adds Dr. Vitale "it promises to have a major effect on how we treat young people with scoliosis." Additional therapies may include:

• VEPTR. The Vertical Expandable Prosthetic Titanium Rib (VEPTR) straightens the spine and opens a larger space for the lungs and other internal organs to grow by placing a titanium brace between two ribs to push them apart. VEPTR can be expanded as the patient grows through an outpatient procedure.
• Growing Rod. Attached to the spine and affixed to vertebrae at the top and the bottom, growing rods are expanded over time using a mechanism that allows the lengthening to be performed in a simple outpatient surgery. The approach minimizes spinal deformity, and most importantly allows lung development to occur to preserve a normal life span for the patient.

Scoliosis

Scoliosis is a musculoskeletal condition that primarily affects children and adolescents, in which there is an abnormal lateral curvature of the spine, causing the spinal column to bend to the left or right. The name is derived from the Greek word "skoliosis," which means "crookedness." Scoliosis affects approximately 3 percent of the population. The Adam's bend test is performed to gauge the amount of curvature a scoliosis patient has. Scoliotic curve is said to exist when the angle of the curve measure is at least 10 degrees. Curves of more than 40 degrees are considered severe. Most patients are diagnosed between ages 10 and 15, although those with severe cases may be detected earlier. Dr. Vitale is a proponent of school screening of adolescents for scoliosis, and authored an informational statement on the subject that was published in the January 2008 issue of the Journal of Bone and Joint Surgery. His position is shared by American Academy of Orthopaedic Surgeons (AAOS), the Scoliosis Research Society (SRS), the Pediatric Orthopaedic Society of North America (POSNA) and the American Academy of Pediatrics (AAP).