Pulmonary and Radiographic Outcomes of VEPTR (Vertical Expandable Prosthetic Titanium Rib) Treatment in Early-Onset Scoliosis

Dede, Özgür; Motoyama, Etsuro K.; Yang, Charles I.; Mutich, Rebecca L.; Walczak, Stephen A.; Bowles, Austin J.; Deeney, Vincent F.

doi:10.2106/jbjs.m.01218

Cited by 51 publications

(17 citation statements)

References 29 publications

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“…Dede et al reported that the use of VEPTR in children with early-onset scoliosis due to a variety of conditions led to large improvements in FVC (a 45% improvement (0.31 L) at 72 months). [19] However, similar to our results, these children had reduced percent predicted FVC (77% to 58%). [19] Other work however, has shown increases in percent predicted FVC.…”

Section: Discussionsupporting

confidence: 88%

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Radiographic and Respiratory Effects of Growing Rods in Children With Spinal Muscular Atrophy

Lenhart¹,

Youlo

Schroth

et al. 2017

Journal of Pediatric Orthopaedics

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Background Respiratory weakness and spinal deformity are common in patients with Spinal Muscular Atrophy (SMA). Posterior (distraction type) growing rods have recently gained favor as a treatment option in this population, due to their ability to prevent spinal deformity progression and their potential to allow lung volumes to increase over time. The objective of this study was to determine the impact of posterior growing rods on the spinal alignment and respiratory function in children with SMA with intermediate term follow-up. Methods A single center, retrospective review was performed on SMA patients treated with growing rods, inserted between 2004 and 2010, with a minimum of two-year follow-up. SMA type, changes in the route of bi-level positive airway pressure respiratory support and the amount of time receiving respiratory support are reported. Pulmonary function tests (PFTs) and radiographs were reviewed and data evaluated pre-insertion, post insertion, and at latest follow-up. Results Sixteen children with SMA (five Type I, eleven Type II) met inclusion criteria. The average age of insertion was 5.8 (+/−1.5) years, the median number of lengthenings was 4 (range 3-5), and the median time between insertion and last clinical review was 4.7 (range 2.7-9.5) years. Radiographic review demonstrated significant (p<0.05) improvements in the following: Spinal curve magnitude, pelvic obliquity, space available for the lung, rib vertebral angle difference, and thoracic kyphosis following growing rod implantation. Thoracic and lumbar height and chest width and depth increased significantly (p<0.05) over the lengthening process. None of the patients initially required more than non-invasive positive pressure ventilation (NIPPV) support. Fifteen of the sixteen experienced no changes in their NIPPV support needs throughout the study duration, requiring support only at night and naps. Serial PFTs were available for six children with SMA Type II. PFTs demonstrated significant improvements in absolute forced vital capacity (FVC), minimal changes in the maximal inspiratory and expiratory pressures, and a gradual worsening of percent predicted FVC. Conclusions Clinical respiratory support requirements appear to stabilize following the insertion and lengthening of posterior based growing rods in the SMA population. Similar to previous studies, increased spinal height and thoracic cavity size were noted throughout the process. Despite an increasing absolute FVC, the percent predicted FVC diminished over time. Level of Evidence Therapeutic Level IV

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Section: Discussionsupporting

confidence: 88%

“…[19] However, similar to our results, these children had reduced percent predicted FVC (77% to 58%). [19] Other work however, has shown increases in percent predicted FVC. A study of six children with neuromuscular disease with magnetic growing rods showed an improvement of 14% percent predicted FVC at an average of 30 months of follow-up.…”

Section: Discussionsupporting

confidence: 88%

Radiographic and Respiratory Effects of Growing Rods in Children With Spinal Muscular Atrophy

Lenhart¹,

Youlo

Schroth

et al. 2017

Journal of Pediatric Orthopaedics

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“…55 With longer periods of follow-up (mean 6 years) during and at the completion of growing construct surgery, FVC as a percentage of normal declined by an average of 28%. 56,57 There are no untreated control groups to assess what loss of lung function might have occurred in the natural progression of the spine deformities. The implication of these studies is that lung function is not normalized or predictably improved after treatments for EOS but that progressive loss of lung function may be reduced with treatment.…”

Section: Pulmonary Outcomes Of Recent Eos Treatmentmentioning

confidence: 99%

Early-Onset Scoliosis: A Review of History, Current Treatment, and Future Directions

et al. 2016

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Early-onset scoliosis (EOS) is defined as curvature of the spine in children >10° with onset before age 10 years. Young children with EOS are at risk for impaired pulmonary function because of the high risk of progressive spinal deformity and thoracic constraints during a critical time of lung development. The treatment of EOS is very challenging because the population is inhomogeneous, often medically complex, and often needs multiple surgeries. In the past, early spinal fusion was performed in children with severe progressive EOS, which corrected scoliosis but limited spine and thoracic growth and resulted in poor pulmonary outcomes. The current goal in treatment of EOS is to maximize growth of the spine and thorax by controlling the spinal deformity, with the aim of promoting normal lung development and pulmonary function. Bracing and casting may improve on the natural history of progression of spinal deformity and are often used to delay surgical intervention or in some cases obviate surgery. Recent advances in surgical implants and techniques have led to the development of growth-friendly implants, which have replaced early spine fusion as the surgical treatment of choice. Treatment with growth-friendly implants usually requires multiple surgeries and is associated with frequent complications. However, growth-friendly spine surgery has been shown to correct spinal deformity while allowing growth of the spine and subsequently lung growth.

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“…15,20,23 Studies on spine distraction showed increased spine kyphosis following repeated lengthening. 15,20,23 Studies on spine distraction showed increased spine kyphosis following repeated lengthening.…”

Section: Discussionmentioning

confidence: 99%

“…[12][13][14][15][16][17][18][19] Despite these benefits, a concern has been raised that serial posterior distraction surgeries may progressively lead to less spine growth. 14,16,23 Subsequently, VEPTR has been applied to other spine conditions including EOS without ribs anomalies. The authors demonstrated that most scoliosis correction and length gain was achieved at the time of initial implantation followed by lower gain with the subsequent lengthening surgeries.…”

mentioning

confidence: 99%

VEPTR Implantation to Treat Children With Early-Onset Scoliosis Without Rib Abnormalities: Early Results From a Prospective Multicenter Study

El-Hawary

Kadhim²,

Vitale³

et al. 2017

Journal of Pediatric Orthopaedics

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Pulmonary and Radiographic Outcomes of VEPTR (Vertical Expandable Prosthetic Titanium Rib) Treatment in Early-Onset Scoliosis

Abstract: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Cited by 51 publications

References 29 publications

Radiographic and Respiratory Effects of Growing Rods in Children With Spinal Muscular Atrophy

Radiographic and Respiratory Effects of Growing Rods in Children With Spinal Muscular Atrophy

Early-Onset Scoliosis: A Review of History, Current Treatment, and Future Directions

VEPTR Implantation to Treat Children With Early-Onset Scoliosis Without Rib Abnormalities: Early Results From a Prospective Multicenter Study

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