The Effect of Opening Wedge Thoracostomy on Thoracic Insufficiency Syndrome Associated with Fused Ribs and Congenital Scoliosis

Campbell, Robert M.; Smith, Melvin D.; Mayes, Thomas C.; Mangos, J. A.; Willey-Courand, Donna Beth; Köse, Nüsret; Pinero, Ricardo F.; Alder, Marden E.; Duong, Hoa L.; Surber, Jennifer L.

doi:10.2106/00004623-200408000-00009

Cited by 310 publications

(186 citation statements)

References 22 publications

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“…Radiographic measures included thoracic spinal height, hemithoracic height (both sides), hemithoracic width (both sides), and Cobb angle [7]. Using an AP radiograph, hemithoracic height was measured from the top of the lung apex at the center of the upper most rib to the inferior rib one or two levels below the dome of the hemidiaphragm [2,5]. The ratio of the height of the concave hemithorax compared with that of the convex hemithorax, expressed as a percentage, is considered to be the space available for the lung [5].…”

Section: Methodsmentioning

confidence: 99%

“…The ratio of the height of the concave hemithorax compared with that of the convex hemithorax, expressed as a percentage, is considered to be the space available for the lung [5]. The thoracic spinal height was calculated by measuring from the top of the first thoracic vertebrae to the bottom of the T-12 equivalent vertebrae [2].…”

Section: Methodsmentioning

confidence: 99%

“…The dysplastic anatomy of the vertebral column and truncal weakness in myelodysplasia together often cause progressive spine and chest wall deformity in a paralytic spine leading to thoracic insufficiency. Primary thoracic insufficiency syndrome (TIS) is defined by Campbell and Smith as the inability of the thorax to support normal respiration or lung growth and may be the result of thoracic spine and chest wall deformity adversely affecting lung function and growth [2][3][4][5]. Secondary TIS is commonly encountered in nonambulatory patients with myelodysplasia as a result of decreased space available for the lung and decreased tidal volume as the diaphragm is forced cephalad by a collapsing spinal deformity or short trunk.…”

Section: Introductionmentioning

confidence: 99%

“…The vertical expandable prosthetic titanium rib (VEPTR) has the mechanical ability to control spinal deformity and allow for continued vertebral column lengthening and lung parenchymal growth [2][3][4]. VEPTR instrumentation allows for fixation lateral from the scar midline incision and absent or abnormal posterior elements of the myelodysplastic spine, potentially decreasing the risk of infection and increasing the corrective moment arm.…”

Section: Introductionmentioning

confidence: 99%

“…Scheduled expansions of the VEPTR implants enable continuous growth of the spine. Therefore, VEPTR should be considered as an alternative operative technique to address the pathology in the skeletally immature nonambulatory myelodysplastic population [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

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Is the Vertebral Expandable Prosthetic Titanium Rib a Surgical Alternative in Patients with Spina Bifida?

Flynn

Ramírez

Emans

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background Nonambulatory children with myelodysplasia are most likely to develop spinal deformity. As the deformity progresses, the overall health of the patient deteriorates. Traditional management of the deformity with fusion results in a short trunk, crankshaft deformity, and spine and lung growth inhibition. One alternative that potentially minimizes these problems is the vertebral expandable prosthetic titanium rib (VEPTR). Questions/purposes We therefore asked whether the use of the VEPTR in immature nonambulating children with myelodysplasia with spinal deformity would (1) correct deformity; (2) allow growth; and (3) allow adequate respiratory function. Patients and Methods We identified 20 nonambulatory patients with myelodysplasia who were part of a multicenter Investigational Device Exemption study of 214 patients treated with the VEPTR system. Demographics, standard radiographic measurements, pulmonary function parameters, and complications in 16 patients were analyzed. Average age at first surgery was 48.6 months. The minimum followup was 25 months (mean, 59 months; range, 25-164 months). Results The Cobb angle decreased postoperatively in nine patients, increased less than 10°in five patients, and increased less than 20°in two patients. The mean increase in thoracic spinal length (growth) by year after the initial procedure with lengthening was 0.48 cm. Ventilatory function improved in 11 patients and deteriorated in five patients. Intraoperative complications occurred in two patients. Complications directly related to the implant were seven infections and five implant migrations. Conclusions Our observations suggest VEPTR is a reasonable treatment option for spinal deformity in the immature, nonambulatory myelodysplasia population correcting the spinal deformity, allowing spinal growth, and maintaining adequate respiratory function. The rate of complications is within the range reported for spinal fusion using standard approaches.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Is the Vertebral Expandable Prosthetic Titanium Rib a Surgical Alternative in Patients with Spina Bifida?

Flynn

Ramírez

Emans

et al. 2011

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

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Novel use of telescoping growth rods in treatment of early onset scoliosis: An in vivo and in vitro study in a porcine model

et al. 2018

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Introduction Treatment of early‐onset scoliosis (EOS) can be difficult. Various forms of growing rods exist to correct deformity while delaying definitive spinal fusion. The disadvantage of traditional growing rods is need for repeated surgical lengthening procedures. Telescoping growth rods (TelGR) are a prototype new, guided growth technology with a rod mechanism that allows spontaneous longitudinal growth over time without manual lengthening. We hypothesized that the TelGR system will permit unrestricted growth with limited complications through 12 weeks in vivo , and that the range of motion (RoM) in each of three directions and stiffness of the TelGR system would not be significantly different than the rigid rod system in vitro . Materials and Methods In vivo : Six immature pigs were surgically implanted with TelGR with cephalad fixation at T6‐7 and caudal fixation at T14‐L1. Radiographs of the involved vertebral segments were measured postoperatively and after 12 weeks. In vitro : A robotic testing system was utilized for flexibility tests in flexion‐extension (FE), lateral bending (LB), and axial rotation (AR) of eight immature porcine specimens (T3‐T15). Testing was performed on both dual rigid rods and bilateral TelGR with instrumentation at T4‐5 and T13‐14. Results In vivo : Over the 12‐week period, the rod length of the TelGR increased an average of 65 mm. In vitro : TelGR demonstrated significantly increased motion in LB and AR RoM compared with rigid rods. No difference was noted in FE RoM. Discussion The in vivo results in this study showed expected skeletal growth with spines instrumented with TelGR. In vitro findings of increased RoM in AR and LB suggest that the TelGR system may be less rigid than traditional growing rods. Treatment with TelGR might, if proven efficacious in the clinical setting, decrease the need for repeated surgical intervention compared with traditional growing rods. This study adds to the limited body of biomechanical evidence examining guided growth technology.

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Kongenitale Fehlbildungen an der Wirbelsäule

Kinderorthopädie in Der Praxis

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The Effect of Opening Wedge Thoracostomy on Thoracic Insufficiency Syndrome Associated with Fused Ribs and Congenital Scoliosis

Cited by 310 publications

References 22 publications

Is the Vertebral Expandable Prosthetic Titanium Rib a Surgical Alternative in Patients with Spina Bifida?

Is the Vertebral Expandable Prosthetic Titanium Rib a Surgical Alternative in Patients with Spina Bifida?

Novel use of telescoping growth rods in treatment of early onset scoliosis: An in vivo and in vitro study in a porcine model

Kongenitale Fehlbildungen an der Wirbelsäule

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