Bilateral use of the vertical expandable prosthetic titanium rib attached to the pelvis: a novel treatment for scoliosis in the growing spine

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Few options exist for the treatment of severe, early onset scoliosis. Goals of treatment include stabilizing curve progression while allowing for normal spine, chest, and lung growth. The vertical expandable prosthetic titanium rib (VEPTR) is a novel device designed to control the spine deformity while permitting lung and spine growth. In this paper the authors report their experience with using bilateral VEPTRs from the ribs to the pelvis for children with severe, early onset scoliosis.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Eleven children were identified who had been treated with bilateral VEPTRs from the ribs to the pelvis. The authors conducted a retrospective review and collected the following data: clinical diagnosis, age at surgery, number of lengthening procedures, and complications. In addition, pre- and postoperative radiographs were reviewed to measure maximum Cobb angle (both thoracic and lumbar), thoracic height, total spine height as measured from T-1 to S-1, thoracic kyphosis (T2–12), and lumbar lordosis (L1–S1).</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>The average patient age at surgery was 71 months; the mean preoperative thoracic Cobb angle was 81.7°. This angle was corrected to 50.6° immediately postoperatively, and this correction was maintained; at the most recent follow-up the curves averaged 58°. Similarly, the preoperative kyphosis (T2–12) angle measured 43° preoperatively, 23° immediately postoperatively, and 37° at the most recent follow-up evaluation. The patients underwent a total of 41 lengthening procedures (average 3.7 lengthening procedures per patient), and overall spine length increased from 23.1 cm preoperatively, to 27.3 cm immediately postoperatively, to 29.4 cm at the final follow-up (an average of 25 months). Four (36.4%) of the 11 patients experienced complications.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>The VEPTR offers a viable treatment option for children with severe, early onset scoliosis. It achieves and maintains spinal deformity correction, while allowing for continued spine and chest-wall growth. Complication rates are similar to those reported for other growing systems.</jats:p></jats:sec>

Surgical Treatment of Spinal Deformities in Young Paraplegic Children with Intraspinal Tumors

“…Because of the small number of 4 children, a neuromuscular cohort of 4 patients was matched and analyzed. Scoliosis correction for both groups was similar to that described in the literature but higher than in rigid spinal deformities in congenital scoliosis patients [6,7,[17][18][19]. Spinal flexibility was similar in both groups analyzing traction films prior to surgery.…”

Pediatric Spinal Cord Injury

“…Spinal fusion would result in a short trunk and impaired lung development. Also the anterior portion of the spine continues to grow after posterior fusion in a young child, resulting in rotational deformities, known as a crankshaft phenomenon [16]. Procedures such as single or dual growing rods or vertical expandable prosthetic titanium ribs have been successfully used in young children with neuromuscular scoliosis to achieve curve correction, improve thoracic height and allow for continued spine growth until the child is old enough for definitive fusion [16,17].…”

Die operative Behandlung von Skoliosen mit dem „vertical expandable prosthetic titanium rib“ (VEPTR)

“…Neurogene Skoliose mit Beckentiefstand [10] Abbildung 15 Es ist notwendig, von der Rippe, üblicherweise der siebten oder achten, zum Becken hin zu instrumentieren. Es ist darauf zu achten, die Strecke nicht zu lang zu wählen, der Patient muss sich in der BWS noch beugen können.…”

“…Das Risiko eines Ausrisses wird damit deutlich vermindert. In der Literatur finden sich Komplikationsraten zwischen 10% und 36% [1][2][3][9][10][11][12][13][14].…”