Radiographic Outcome and Complication Rate of 34 Graduates After Treatment With Vertical Expandable Prosthetic Titanium Rib (VEPTR): A Single Center Report

Abstract

Background: The final strategy for graduates from growthsparing surgery is challenging. The purpose of this study was to evaluate the radiographic outcome and complications of patients with early onset scoliosis (EOS) who have graduated from vertical expandable prosthetic titanium rib (VEPTR) treatment, either undergoing final fusion surgery or following a nonfusion approach. Methods: Final treatment for VEPTR graduates was divided in "VEPTR in situ without final fusion," "removal of VEPTR without final fusion," and "removal of VEPTR with instrumented final fusion." Radiographic evaluations included main coronal Cobb angle and main kyphosis pre and post VEPTR implantation, at the end of implant lengthening, after final fusion (if applicable), and at latest follow-up. Complications during VEPTR treatment and in case of final fusion were reported. Results: In total, 34 VEPTR graduates were included; 17 underwent final fusion surgery, and 17 followed a nonfusion strategy. Average coronal Cobb angle before VEPTR implantation was 70 ± 23 degrees (range, 21 to 121 degrees), and 65 ± 22 degrees (range, 17 to 119 degrees) at latest follow-up. Average main kyphosis angle was 53 ± 27 degrees (range, 6 to 137 degrees) before VEPTR, and 69 ± 34 degrees (range, 10 to 150 degrees) at latest follow-up. There was a 41% complication rate with final fusion surgery. Conclusions: There is a high complication rate during VEPTR treatment and with final fusion surgery. The stiffness of the spine and thorax allow for only limited correction when performing a final instrumented spondylodesis. Avoiding final fusion may be a viable alternative in case of good coronal and sagittal alignment. Level of Evidence: Level IV-therapeutic.

Diagnostic and therapeutic strategies in early onset scoliosis: A current concept review

“…38 Previous evidence of outcomes after final fusion with modest correction and high complication and reoperation rates, both in VEPTR patients and with other growth-friendly systems, prompted to rethink the original idea of controlling the deformity during growth and aiming for significant correction with conversion to final fusion (Figure 2). [39][40][41] Due to the more restrained use of VEPTR in recent years, there are only few valid data regarding patient-reported outcome. The complication-prone course and the necessity for repetitive surgical lengthening with encumbering cosmetic consequences explain the poor evaluations in regard to "pain", "self-image", and "function" (Figure 3).…”

“… 38 Previous evidence of outcomes after final fusion with modest correction and high complication and reoperation rates, both in VEPTR patients and with other growth-friendly systems, prompted to rethink the original idea of controlling the deformity during growth and aiming for significant correction with conversion to final fusion ( Figure 2 ). 39 – 41 …”

Do Rib-Based Anchors Impair Chest Wall Motion in Early Onset Scoliosis (EOS)?

“…There is a concern in pediatric spine deformity surgery that rib-based fixation may limit chest wall motion. This philosophy stems from the fusion mass created by device migration, the law of diminishing returns and auto fusion identified in EOS at the time of final fusion, and the complex thoracic cage osteotomies needed at time of graduate final fusion surgery needed to correct severe deformity [19][20][21].…”