- Learn about traditional treatments for pain relief to bridge from inactivity to physical therapy
“Vertebral body stapling is an innovative, minimally invasive approach that is an alternative therapy for early onset scoliosis,” explains Dr. Geck. “What we're trying to do is to preserve the long-term motion of the spine.”
The procedure, which was developed about eight years ago by orthopaedic surgeon James Ogilvie, M.D., of the University of Utah and brought into wider clinical use by Randal Betz, M.D., at Temple University in Philadelphia, involves placing staples along the vertebral growth plate to modulate the asymmetrical growth. By slowing the anterior growth of the spine, the lateral side can catch up. At the two-year follow-up of patients, 80 percent of the patients had either stabilized or improved. The best outcomes were among children 8 to 11 years old.
The best patients for vertebral body stapling have a curve between 25 degrees and 35 degrees in an age group of 8- to 11- year-olds. The staples are made of a substance called nitinol, a nickel-titanium alloy that has “shape memory.” When they are cold, they can be in an open position for surgical implantation. When they warm to body temperature, they resume their original shape and clamp onto the vertebrae. “The metal flexes and allows for continued movement of the spine,” said Dr. Geck. Even the most intense athletes can resume their activities after recovery. “Gymnasts can still do back handsprings,” he said.
Dr. Geck is one of the early adopters of the new technique, and often uses it in combination with either VATS (video assisted thoracoscopic surgery, a minimally invasive approach to the thoracic spine) or and XLIF or DLIF approach (a extreme or far lateral minimally invasive approach to the lumbar spine). “To my mind, it makes more sense to combine minimally invasive surgical approaches with vertebral body stapling to minimize the impact on the patient's growing body,” says Dr. Geck.
Still, vertebral body stapling is part of a continuum of modalities. Patient selection is critical, said Dr. Geck, scoliosis surgeon in Austin who serves the communities of Houston, Waco and San Antonio. “You have to pick the right candidate, the right curve and the right reason,” he said. It is the most effective with curves from 25 degrees to 35 degrees. If the curve is greater, spinal fusion is still the treatment of choice, and mild curves may respond to bracing. In fact, a new genetic test (see ScoliScore genetics test) has been developed that can indicate necessity. “However, for these patients whose curve is too large for stapling, our minimally invasive scoliosis techniques may offer advantages over open scoliosis reconstruction.”
Patients also must be young enough to have a period of growth that can be impacted by the staples. “The earlier we detect it, the more options we have to get the progression of scoliosis under control with much higher success rates,” Dr. Geck said. In about 20 percent of vertebral body stapling cases, the scoliosis continues to advance and spinal fusion is necessary. But this “failure” is among children who would otherwise have had spinal fusion anyway. Those with successful outcomes were able to avoid the more significant reconstructive fusion surgery.
Dr. Matthew Geck discusses benefits of Vertebral Body Stapling on KLBJ in Austin, Texas
Click here or click the image to the left to listen to Dr. Geck talk with Perry Watson of KLBJ. This media clip used courtesy of Radio Station, 590KLBJ, in Austin,Texas.