ABSTRACT
A cervicothoracic lumbosacral orthosis or a thoracolumbosacral orthosis is semi-custom or fully custom-made for the patient’s specific scoliosis pattern and body dimensions. One early patient had a segmental spinal vein that was punctured by a staple prong, requiring conversion of the thoracoscopic portal to a mini-incision, and ligation of the vein. The search for an alternative to brace treatment reintroduced an old concept to the research forefront. Angular limb deformity in skeletally immature patients can be corrected with asymmetric physeal compression using metal staples on the convex side of the limb. Staples are placed anterior to the rib heads and if the patient has severe hypokyphosis or thoracic lordosis, the staples can be placed more anterior on the vertebrae to help produce kyphosis. Minimal access surgery can also be used to place staples in the lumbar spine. Segmental vessels or other regional veins may need to be ligated to provide access to the intervertebral discs and endplates.
