What is Vertebral Body Stapling?
1) A new, nonfusion technique used for the management of scoliosis in the thoracic and lumbar spine in skeletally immature patients.
2) The concept of stapling the anterior vertebral growth plates for growth modulation and curve stabilization has proven to be effective in animals and humans on the convex side of the scoliosis.
3) The effect of the staple is to reduce the rate of growth.
This is a possible alternative to bracing for patients who are at risk for a seedy progression of the curve, and who may need a spinal fusion in the future.
Allowing for preserved motion and less chance of back pain in adulthood.
Who is a candidate for vertebral body stapling?
- Idiopathic scoliosis
- A child older than 8 years
- A child who will still have years of growth - boys up to 16 years and girls up to 14 years
- Curve less than 45 degrees
- Spine Flexibility
- Neurologically normal individuals
Which spinal curves can be stapled?
Both thoracic and lumbar curves
Who designed the staple?
Dr. Randy Betz has worked to develop the current staple design. At present he and his associates have treated several hundred young scoliosis patients with this technique.
How effective is vertebral body stapling?
Based on personal discussions with Dr. Randy Betz, and his two publications on Vertebral Body Stapling in peer-reviewed journals, vertebral body stapling is equally effective as bracing.
What are the advantages of Vertebral Body Stapling?
Patients who undergo Vertebral Body Stapling do not need a brace and have an equal chance the scoliosis will not progress to need a spine fusion.
What are the disadvantages of Vertebral Body Stapling?
It is a surgery with all the inherent risks of surgery.
What type of metal are the staples?
They are a combination of nickel and titanium called NITINOL, for Nickel Titanium Naval Ordinance lab. Nitinol has unique thermodynamic properties that allow it to change it shape based on the temperature or the metal. Near 0 degrees (in an ice bath) the tines of the staple are straight, and as the staples warm to body temperature the tines curve inward, and remain so in the body, in a C-shape.
What does the procedure involve?
- Patients will have a preoperative visit two to four weeks prior to procedure.
- The procedure is done under general anesthesia in the operating room.
- The procedure is performed with a thorascope
- A camera on the end of a long tube which enables surgery to be performed with a small incision on the chest.
- Staples are places over the convex side of the curve (usually the right side)
- The procedure is approximately 2 hours in length.
- A chest tube is placed to drain in air and fluid out of the chest for the first 2 days after surgery
- Patients will typically be in hospital for 4 days.
- Patients spend first night in the ICU.
- Patients will then go to the 10th floor (the orthopedic floor).
What happens to the staples?
In the largest series of patients at Shiner’s hospital in Philadelphia no staples have broken or migrated. Due to the c-shape of the staples after they are implanted they cannot back out, loosen and travel in abdomen or chest.
What happens if the curves progress despite the stapling?
It depends on the amount of progression. Slight progression may occur, but likely will not need to be treated (such as a spine fusion). However, significant progression of the curves can still be treated with a spine fusion without difficulty.
Frequently Asked Questions...
What do I need to bring to the hospital?
You may bring:
- Current List of Medications, dosages and frequency
- Personal Items of comfort (blanket, stuffed animal, books, movies)
- Toiletry items you feel you will need during your stay
- Comfortable clothes for day of going home
Can my mom, dad or caregiver stay at the bedside?
- In the Pediatric Intensive Care Unit (PICU) two people can visit at a time, but they can not sleep in the room with the patient.
- Parents can sleep in the PICU lounge.
- On the Floor- One parent can sleep at the bedside. The other parent can sleep in the parent lounge. Typically there is not a roommate. If there is not a roommate… both parents are welcome to stay the night.
What do we do the night before surgery?
- If you live far…you may want to stay at a local hotel because you will be required to be here early. ( about 6 am)
- The patient may not have anything to eat or drink after Midnight
- Please shower thoroughly shampooing your hair the night prior to surgery
- Please remove any nail polish, and be sure your nail beds are clean for surgery.
Same Day Surgery:
The 6th Floor Same Day Surgery Unit is where you and your family will begin your journey. The day of surgery you will be able to meet with the, anesthesiologist, child life therapist and nurses. Your weight, height and vitals signs will be obtained. You may be given medication prior to surgery by the nurse.
You will be able to pick a flavor for the mask that will help us put you to sleep. While you are a sleep, we will place an IV (intravenous catheter) in order to provide fluids and pain medication.
Your abdomen/chest will be cleaned prior to surgery with special soap. Gel pads and pillows will be used to have you placed in a comfortable position for surgery.
We will have special electrodes placed on your body to check for neuro/sensory movement. We will ask you at times to move parts of your body. You will not fully be awake. You will have pain medication that will keep you comfortable.
Post Anesthesia Care Unit (PACU):
We will wake you up when the surgery is complete. You will then be wheeled in a bed to the PACU. When you are awake, we will be able to call your parent(s) or caregiver to be with you. In the PACU, you will be closely monitored by the doctors and nurses.
Pain Control You will have a Patient Controlled Anesthesia (PCA). This is controlled by the Pain Service Team. The pain service team is a special team of doctors (anesthesiologists) and nurses who are trained in monitoring your post operative pain. If the patient is able to comprehend, the patient will be able to press the button for pain medication. The patient may also be delivered medication continuously through the PCA.
Pediatric Intensive Care Unit/PICU:
Patients will typically stay at least one night in the PICU. The PICU is set up to allow close patient monitored care. The nurses in the PICU will have 1-2 patients at a time depending on the acuity.
Parents are allowed to visit, but they are not allowed to sleep in the PICU. There is a parent lounge with lockers to hold personal items and chairs that pull out for sleep.
Patients will be turned approximately every 2 hours while in the hospital. Patients will be turned using the log roll method. The nurses and physical therapists will go over with the family how to turn the patient properly. The physical therapist will be available to get the patient out of bed for the first time the morning after surgery. Some patients may have to wait until the brace is available.
Patients will have a chest tube for 2 days after surgery. The patient will require daily chest x-rays until the chest tube is removed. The patient will also require another x-ray a few hours after chest tube removal. The occlusive dressing placed on patient after chest tube removal will remain on patient for 72 hours.
Pain medication will be delivered through the PCA until the pain service has made a decision to change to oral medications. Typically the patient needs to be drinking, eating, and tolerating a diet for this to occur.
It is important for the patient to use the incentive spirometer to encourage pulmonary toilet. The patients can also do things like blow bubbles or pretend to blow out candles of a birthday cake. The patient with a history of asthma, CP, or neuromuscular issues may have respiratory therapy involved with either breathing treatments and or continuous pulmonary toileting CPT (every four hours).
For girls, typically surgery can change ones cycle. It is not out of the ordinary for one to have their menstrual cycle after surgery.
Lab work will be obtained for at least the first three days after surgery. The nurse or lab technician will be taking blood by sticking the patient’s finger or by a venous stick with a small butterfly needle.
Surgical Floor/ 10th Floor:
The typical stay for a patient in the hospital is 4 days. Patients are typically transferred to the 10th floor which is home to the orthopedic patient. This is a 30 bed unit with both single and double rooms. You may have a roommate.
The 10th floor has a parent lounge and small kitchen with a refrigerator and microwave.
Patients are turned every two hours. Patients need to be up out of bed two to three times a day. For the patient to be up out of bed the patient will need sit in the bedside chair, wheelchair or ambulate in the hall.
Pain medication is adjusted per the Pain Service.
It is important for patients to use the incentive spirometer, blow bubbles and or pretend to blow out candles on a birthday cake. The bedside nurse will be able to assist with this. These are all ways to help expand the lungs. Some patients will require respiratory therapy.
The typical stay for a patient in the hospital is 4 days.
Patients are ready to go home when pain is well under control, tolerating a diet, and cleared from physical therapy.
Patients will be sent home with a prescription for pain medication and a stool softener.
Follow up in 4 weeks after surgery. You can call Debbie when you are at home after surgery.
Try to plan going home with medication timing. The outpatient pharmacy is located on the first floor near the information desk. The ride in the car can often be bumpy! Bring your pink bucket home just in case you get sick to your stomach.
2 weeks after surgery -The patient may shower, bath or swim in a chlorinated or salt water pool. NO swimming in natural body of water for 6 weeks.
No athletic activities for the first month after surgery.
When to call the doctor
- incision site redness, warmth or drainage
- numbness tingling or weakness in your arms or legs
- change in bowel or bladder pattern
- increased pain not relieved by pain medication
Follow Up Appointments
- Four weeks
- Three months
- Six months
- One year
Further followup will be individualized to each patient.
1. Betz RR, D’Andrea LP,Mulcahey MJ, Chaftetz RS. Vertebral body stapling procedure for the treatment of scoliosis in the growing child. Clin Orthop Relat Res 2005;434:55-60.
2. Betz RR, Kim J, D’Andrea LP, Mulcahey MJ,Balsara RK,Clements DH. An innovative technique of vertebral body stapling for the treatment of patients with adolescent idiopathic scoliosis: a feasibility, safety and utility study. Spine 2003;28:s255-65.