Vertical expandable prosthetic titanium rib (VEPTR): a review of indications, normal radiographic appearance and complications

Parnell, Shawn E.; Effmann, Eric L.; Song, Kit M.; Swanson, Jonathon O.; Bompadre, Viviana; Phillips, Grace S.

doi:10.1007/s00247-014-3128-4

Cited by 17 publications

(6 citation statements)

References 19 publications

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“…There is a relatively high rate of reported complications with VEPTR in the literature. The potential complications of VEPTR include infection, rib fracture, dislodged hardware and neurological injury [ 115 ].…”

Section: Clinical Treatmentmentioning

confidence: 99%

Effects of spinal deformities on lung development in children: a review

Wang

Zhang

et al. 2023

J Orthop Surg Res

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Scoliosis before the age of 5 years is referred to as early-onset scoliosis (EOS). While causes may vary, EOS can potentially affect respiratory function and lung development as children grow. Moreover, scoliosis can lead to thoracic insufficiency syndrome when aggravated or left untreated. Therefore, spinal thoracic deformities often require intervention in early childhood, and solving these problems requires new methods that include the means for both deformity correction and growth maintenance. Therapeutic strategies for preserving the growing spine and thorax include growth rods, vertically expandable titanium artificial ribs, MAGEC rods, braces and casts. The goals of any growth-promoting surgical strategy are to alter the natural history of cardiorespiratory development, limit the progression of underlying spondylarthrosis deformities and minimize negative changes in spondylothorax biomechanics due to the instrumental action of the implant. This review further elucidates EOS in terms of its aetiology, pathogenesis, pathology and treatment.

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Section: Clinical Treatmentmentioning

confidence: 99%

Effects of spinal deformities on lung development in children: a review

Wang

Zhang

et al. 2023

J Orthop Surg Res

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Section: Surgical Managementmentioning

confidence: 99%

“…The procedure presents with high rate of neurological complications of 7% with brachial plexus palsy being the most common ( 68 ). Rib and lamina fractures, infection and lesions are also common events ( 68 ). Device ossification can be seen postoperatively which leads to severe loss of chest compliance ( 68 ).…”

Section: Surgical Managementmentioning

confidence: 99%

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Congenital scoliosis: a narrative review and proposal of a treatment algorithm

et al. 2022

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Congenital scoliosis (CS) is a spinal deformity resulting from underlying spinal malformations with an incidence of 0.5–1/1000 births. CS makes up 10% of scoliotic deformities, of which 25% do not progress, 25% progress mildly and 50% need treatment depending on the age, curve characteristics and magnitude and type of anomaly. CS is associated with non-vertebral anomalies (genitourinary, musculoskeletal, cardiac, ribs anomalies, etc.) and intraspinal anomalies (syrinx and tethered cord). Imaging should include whole spine X-rays, CT scanner with reconstruction to better delineate the vertebral anomalies and MRI to visualize the neural elements. Treatment of CS in the majority of cases is non-surgical and relies on fusion techniques (in situ fusion and hemiepiphysiodeis), resection techniques (hemiverterba resection), and growth-friendly techniques (distraction and instrumentation without fusion).

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“…Multi-staged surgical treatment of EOS is associated with frequent complications following distraction-based treatment and final fusion due to a variable severity of the underlying condition and medical comorbidities. 6,7 EOS includes an inhomogeneous grouping of patients with different etiology of the spinal deformity, and many studies are limited by a small number of observations. [8][9][10][11] Based on the experience, a surgeon may question if the final fusion is actually needed with the multiple and extensive spontaneous bone block in the spine and ribs developing at the site of distractors.…”

Section: Introductionmentioning

confidence: 99%

Final fusion in a complex of surgical treatment for early onset scoliosis

Mikhaylovskiy¹,

Ryabykh²,

Suzdalov³

et al. 2021

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Introduction: Surgical treatment of early onset scoliosis (EOS) is one of the most challenging problems of spine surgery and includes staged distraction and final fusion at the end of skeletal maturity that remains debatable. Aim: The objective of the review is to evaluate the efficacy of final fusion following staged distraction with VEPTR instrumentation in patients with EOS. Materials and methods: Outcomes of multi-staged operative treatment of 37 patients with EOS of different etiology were reviewed. Medical records and radiographs of the patients were retrospectively analyzed. Standing postero-anterior and lateral spine radiographs were used for the spinal radiologic assessment before and after each stage of distraction-based treatment, before and after final fusion and at the last follow-up. Results: The mean age of patients at baseline was 5.2 years and the mean age at final fusion was 13.9 years. All patients demonstrated decrease in the angle of primary (from 81.5° to 51.6°) and secondary (from 59.3° to 37.8°) curves, increase of the height and normalized body balance. The mean height increased from 104.8 cm to 141.0 cm, and the mean weight increased from 15 kg to 35 kg throughout the treatment period. The height of the thoracic and lumbar vertebra (Th1-S1) increased from 245 mm to 340 mm, and that of the thoracic vertebra – from 136 mm to 193 mm. There was a mean of 2.3 complications per patient during distraction performed in a staged manner, and they were arrested during elective procedures. There were 7 (19%) complications after final fusion that required 6 (16%) unplanned revisions. Radiologic evidence of spontaneous autofusion was seen in the lumbar spine of the patients with the inferior anchor at the lumbar vertebra. Conclusions: Multi-staged pediatric surgeries performed in the first decade of life facilitate radical changes in the natural history of progressive scoliosis and ensure satisfactory functional and cosmetic results despite multiple difficulties and complications. The VEPTR instrumentation used for the thoracic curve is unlikely to result in the spinal fusion of the major arch and this is the cause for the use of third-generation instrumented final spinal fusion in the patients. 

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Vertical expandable prosthetic titanium rib (VEPTR): a review of indications, normal radiographic appearance and complications

Cited by 17 publications

References 19 publications

Effects of spinal deformities on lung development in children: a review

Effects of spinal deformities on lung development in children: a review

Congenital scoliosis: a narrative review and proposal of a treatment algorithm

Final fusion in a complex of surgical treatment for early onset scoliosis

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