The role of bracing, casting, and vertical expandable prosthetic titanium rib for the treatment of infantile idiopathic scoliosis: a single-institution experience with 31 consecutive patients

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>There are few data on treatment results for patients with idiopathic infantile scoliosis (IIS). Thus, the authors have performed a retrospective review of their experience with treating these patients, particularly as newer technologies, such as the vertical expandable prosthetic titanium rib (VEPTR), emerge.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>This retrospective study was conducted to evaluate the methods of treatment used to manage IIS at a single institution. The authors reviewed 31 consecutive patients with a primary diagnosis of IIS. Patients were screened to ensure that there were no confounding congenital anomalies or comorbidities that may have contributed to the spinal deformity. The average age at the time of initial treatment was 25 months. Treatment modalities included bracing, serial body casting, and VEPTR. Pretreatment, posttreatment, and most recent Cobb angles were compared to assess the overall curve correction, and patient charts were reviewed for the occurrence of complications.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Of the 31 patients, 17 were treated with a brace, 9 of whom had curve progression and went on to other forms of treatment. Of the 8 who did respond, there was an overall improvement of 51.2%. The 10 patients who received body casts, who had a mean preoperative Cobb angle of 50.4°, demonstrated an average correction of 59.0%, with only a few skin irritations reported. The 10 patients treated with VEPTR devices demonstrated a mean preoperative Cobb angle of 90.0°, and an average correction of 33.8% was attained. Three of the VEPTR-treated patients (33%) experienced minor problems.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>The authors' results suggest that body casting has utility for appropriately selected patients; that is, those with smaller, flexible spinal curves. Bracing had limited utility, with high levels of progression and the need for secondary treatments. The VEPTR device appears to be a viable alternative for large-magnitude curves.</jats:p></jats:sec>

Early Definitive Spinal Fusion in Young Children: What We Have Learned

“…New surgical techniques that allow expansion of the thorax and growth of the spine through thoracoplasty with implantation of expandable rib devices or dual growing spinal rods without fusion offer the potential for continued pulmonary development in young children with severe deformities [1,2,9,17]. Early reports of maintenance and even improvement in pulmonary function have recently been published [29,45,46]. Continued research is needed to establish more effective treatments for the youngest children with severe spinal deformity.…”

Use of a Vertical Expandable Prosthetic Titanium Rib in Children With Thoracic Insufficiency Syndrome and Scoliosis

“…Other conditions in which a VEPTR has been used include multiple congenital spine deformities, early-onset progressive neuromuscular scoliosis, congenital scoliosis, early-onset scoliosis, infantile idiopathic scoliosis, and myelomeningocele kyphosis. [9][10][11][12][13] Only a few published articles delineate experience with VEPTR devices in treating TIS in spondylocostal dysplasia, 14 infantile idiopathic scoliosis, 15,16 and thoracic kyphosis. 2 In a retrospective review published in 2011, Reinker et al 11 examined VEPTR devices as a means to control progressive kyphoscoliosis.…”

“…In children with infantile idiopathic scoliosis who had VEPTR implantation, 3 of 9 patients (33%) had complications, including erosion of rib at the VEPTR attachment site in 2 patients and 2 weeks of lower extremity pain postoperatively that resolved without intervention. 16 Despite the seemingly high rates of complications, the rates are not weighted and many of the studies had small heterogeneous groups of patients, so an accurate refl ection of the actual risks of treatment is diffi cult. However, in a study by Campbell et al, 17 the sample of 27 patients was relatively homogeneous, with fused ribs and congenital scoliosis.…”

“…Caubet et al suggest that hemoglobin can be used to evaluate the outcomes of these surgical procedures. Standard PFTs in patients old enough and developmentally able to participate in the tests (generally older than 6 or 7 years 16,17 ) are used to determine pulmonary function. 18,19,36 Additionally, specialized PFTs have been used in efforts to measure lung function.…”

Staged corrective surgery for complex adolescent kyphoscoliosis caused by back scalding during the childhood period

“…Observation is used for curves with little growth potential and Cobb angle not more than 20°-30°, and when the extent of contractured scar is not extensive. Braces have a very limited role, and are only used in long flexible curves, secondary curves and as an adjunct to surgery to assist fusion [5]. Surgery is either prophylactic or corrective.…”