Alternative to Bracing for Mild to Moderate Scoliosis in Children
Scoliosis patients as young as 7 years old can now have their spine straightened without bracing.
Cooper’s David H. Clements, MD,FACOS, and Harsh Grewal, MD, FACS, FAAP, are the only surgeons in South Jersey to use vertebral body shaping (VBS) without fusion to correct juvenile and adolescent idiopathic scoliosis (AIS).
“Bracing is a controversial issue in the treatment of scoliosis,” says Dr. Clements. “Poor self image and brace compliance are serious issues for boys and girls. Bracing often leads to failure and even with good compliance, statistics show 18 to 50 percent of curves will progress in spite of bracing.”
The minimally invasive surgery fixes preoperative, thoracic curves measuring ? 35 degrees and all lumbar curves without impairing a child’s flexibility and ability to grow.
VBS CORRECTS CURVES WITH ONE OR VISIT
The two Cooper surgeons perform the surgery in tandem, with Dr. Grewal managing the minimally invasive access via video-assisted thoracic surgery (VATS) technology. Dr. Clements then strategically places the staples along one side of the child’s spine.
Drs. Grewal and Clements combine the expertise they gained over the years working on the team at Shriner’s Hospital for Children®–Philadelphia where the procedure was first developed and refined. Many years, 100-plus patients and numerous published articles later, Shriner’s has the largest experience with VBS fusionless surgery. Cooper now offers the surgery using minimally invasive techniques due to the appointment of Dr. Grewal last March.
During the procedure, Dr. Grewal uses VATS to make small incisions, approximately one to 1.5 inches each along the child’s spine. Dr. Clements then staples up to five levels of vertebrae via each incision, using one, two or three staples at each vertebral segment. The 4 mm and 6 mm staples used are FDA 510(k) approved for clinician directed applications in the spine. They have proven effective on all levels of the Cobb curve – from T5 to L4 – and are effective on curves affecting both the thoracic and the lumbar vertebrae.
OUTSTANDING OUTCOMES AND NO RESTRICTIONS
“Our results are tremendous,” says Dr. Grewal. “The procedure can correct C and S curves, as well as thoracic, lumbar, thoracolumbar and double curves immediately while eliminating the chance of progression. We can fix a child’s entire curve and change the child’s life forever in just a few hours.”
Analysis show two-year success rates include 79 percent for thoracic curves ? 35 degrees and 87 percent for all lumbar curves with no major complications, no evidence of staple dislodgement or migration, and no adverse effects, such as limited movement or pain.
VBS surgery takes about six hours and the average hospital stay is between three and six days. Patients are required to wear a custom, non-correcting, thoracolumbosacral orthosis (TLSO) brace full-time for four to 12 weeks to allow the staples to stabilize. After the brace is removed activity is unrestricted. Patients return for follow-up evaluations at one and two months and then every six months until they stop growing.
Out of every 1,000 children, three to five will develop spinal curves large enough to require surgical intervention. Girls are more likely to have AIS than boys. Scoliosis can also run in families, so any child with a parent or sibling with idiopathic scoliosis is at risk.
Dr. Clements is Director, Orthopaedic Spine Surgery and Director, Scoliosis Program within
Cooper’s Bone and Joint Institute. For questions, or to refer a patient, please call 856.342.3162.
Dr. Grewal is Head, Division of Pediatric Surgery, Department of Surgery at Cooper. For questions, or to refer a patient, please call 856.342.3250.