Vertical expandable prosthetic titanium ribs (VEPTR) in early-onset scoliosis: Impact on thoracic compliance and sagittal balance

Konieczny, Markus Rafael; Ehrlich, A-K.; Krauspe, Rüdiger

doi:10.1302/1863-2548-11-160222

Cited by 9 publications

(6 citation statements)

References 16 publications

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“…Mac-Thiong et al 13 reported that a small increase in PI is observed as age progresses and that this increase is correlated with the increase in PT and that SS is relatively stable. Konieczny et al 12 between the 2 groups during growth. In the current study, absolute increases in PI from preoperatively to the latest follow-up were 4° ± 6° and 3° ± 5° over a period of several lengthening procedures in the VEPTR and GRI groups, respectively, but these increases were not statistically significant.…”

Section: Discussionmentioning

confidence: 99%

Evolution of the postoperative sagittal spinal profile in early-onset scoliosis: is there a difference between rib-based and spine-based growth-friendly instrumentation?

Chen¹,

Song²,

Qiu³

et al. 2017

Journal of Neurosurgery: Pediatrics

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OBJECTIVEAlthough the vertical expandable prosthetic titanium rib (VEPTR) and growing rod instrumentation (GRI) encourage spinal growth via regular lengthening, they can create different results because of their different fixation patterns and mechanisms in correcting scoliosis. Previous studies have focused comparisons on coronal plane deformity with minimal attention to the sagittal profile. In this retrospective study, the authors aimed to compare the evolution of the sagittal spinal profile in early-onset scoliosis (EOS) treated with VEPTR versus GRI.METHODSThe data for 11 patients with VEPTR and 22 with GRI were reviewed. All patients had more than 2 years’ follow-up with more than 2 lengthening procedures. Radiographic measurements were performed before and after the index surgery and at the latest follow-up. The complications in both groups were recorded.RESULTSPatients in both groups had similar diagnoses, age at the index surgery, and number of lengthening procedures. The changes in the major coronal Cobb angle and T1–S1 spinal height were not significantly different between the 2 groups. Compared with the GRI group, the VEPTR group had less correction in thoracic kyphosis (23% ± 12% vs 44% ± 16%, p < 0.001) after the index surgery and experienced a greater correction loss in thoracic kyphosis (46% ± 18% vs 11% ± 8%, p < 0.001) at the latest follow-up. Although the increase in the proximal junctional angle was not significantly different (VEPTR: 7° ± 4° vs GRI: 8° ± 5°, p = 0.569), the incidence of proximal junctional kyphosis was relatively lower in the VEPTR group (VEPTR: 18.2% vs GRI: 22.7%). No significant changes in the spinopelvic parameters were observed, while the sagittal vertical axis showed a tendency toward a neutral position in both groups. The overall complication rate was higher in the VEPTR group than in the GRI group (72.7% vs 54.5%).CONCLUSIONSThe VEPTR had coronal correction and spinal growth results similar to those with GRI. In the sagittal plane, however, the VEPTR was not comparable to the GRI in controlling thoracic kyphosis. Thus, for hyperkyphotic EOS patients, GRI is recommended over VEPTR.

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Section: Discussionmentioning

confidence: 99%

Evolution of the postoperative sagittal spinal profile in early-onset scoliosis: is there a difference between rib-based and spine-based growth-friendly instrumentation?

Chen¹,

Song²,

Qiu³

et al. 2017

Journal of Neurosurgery: Pediatrics

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“…EOS is a spinal deformity with different etiologies in the growing child. Management of such cases is challenging ( 2 , 4 ). with limited treatment options, but whatever the treatment option is our aim is to avoid the problems associated with spinal fusion if done in this age group, and all treatment options aims to allow adequate development of the lung in an adequate lung space and to avoid the crankshaft phenomenon and the problems of dissociated growth of the trunk and the limbs.…”

Section: Discussionmentioning

confidence: 99%

“…The coronal height from T1-S1 continues to grow at a slower rate (9mm/y) between the age of 6 and 10 years and then increases (16-20 mm/y) between the age of 10 years and skeletal maturity Spinal fusion is better to be avoided in young children to prevent long-term complications related to fusion arrested spine growth and subsequently small thoracic volume ( 14 ). Alternatively, fusionless procedures are now commonly used in to limit the progression of scoliosis while enhancing thoracic growth ( 1 , 2 , 4 , 10 , 11 ). The growing rods and rib-based distraction devices [vertical expandable prosthetic titanium rib (VEPTR) have been developed to correct the scoliosis and to increase spine height during early childhood ( 3 , 7 ).…”

Section: Introductionmentioning

confidence: 99%

“…Despite those many advantages, a concern has been raised that serial posterior distraction surgeries may progressively lead to less spine growth with time ( 4 , 8 ). The repetitive surgical lengthening procedures and the high rate of complications is another disadvantage for this implant which we will discuss in our study ( 6 , 9 , 12 , 13 ).…”

Section: Introductionmentioning

confidence: 99%

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Early Childhood Scoliosis Management by Vertical Expandable Prosthetic Titanium Rib (VEPTR): Experience of Royal Medical Services (RMS)

et al. 2020

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Introduction: Scoliosis could develop at the childhood age and progress beyond skeletal maturity. An early spinal fusion arrests growth of the spine and thorax, risking the development of secondary thoracic insufficiency syndrome. Vertical expandable prosthetic titanium rib (VEPTR) is a fusionless technique aiming to correct the deformity with preservation of growth potential. Aim: To show our experience and results regarding the use of VEPTR in children with scoliosis in regard to coronal profiles(length and deformity angle), spinal growth, and the complications we faced during the follow-up of two years after the index procedure. Methods: A retrospective analysis of prospectively collected data of a case series. Forty child with scoliosis of different etiologies. Their primary diagnoses were neuromuscular scoliosis in 13, Juvenile idiopathic scoliosis in12, Congenital Scoliosis in 8, syndromatic patients 5 and 2 with Arthrogryposis. All 40 patients received percutaneous rib-to-pelvis or rib to vertebra or rib to rib VEPTR implantation between January 2016 and January 2018. None of them needed blood transfusion. They underwent 56 primary implantation, 16(40%) bilateral system and 24(60%) unilateral followed by lengthening procedure in a period of 4-6 months. The patients were assessed based on mechanical measures, that is, the radiographic improvement of their scoliosis, spinal height, and sagittal and coronal correction, which are measured and compared preoperatively, immediately postoperatively and at two years follow up, complication encountered during this period are also counted. Results: The average initial correction in Cobb angle immediately after the index surgery was 14.4° (5°-26°) and the average final correction of Cobb which is measured after the last expansion procedure (Cobb angle of the major curve measured after last expansion minus initial preoperative Cobb angle of the major curve) was 7.3° (12%). The average of preoperative coronal T1-S1 length was 25.6 cm with an average initial correction achieved immediately after implantation of VEPTR of2.8 cm (1.2-5.1cm) which is 10.9%, and the average coronal length gain at 2 years follow up was 5.7 cm (3.7-9.8cm) that is 22.2%. Complication occurred in 18 of our patients (45%). Conclusion: Early results of VEPTR for childhood scoliosis are encouraging. Follow-up till skeletal maturity will best determine future indications.

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“…[ 67 ] Various treatment options are available for deformity correction or preventing progression in patients with EOS, which includes cast jackets, growth friendly implants that include distraction-based implants (growth rods, vertical expandable prosthetic titanium rib, magnetically controlled growth rods), guided growth implants (Shilla technique), and compression-based implants. [ 4 68 69 ]…”

Section: Anagement Of I Ntraspinal mentioning

confidence: 99%

Intraspinal anomalies in early onset scoliosis: Current concepts

Singrakhia¹,

Malewar²,

Jangle³

2018

J Pediatr Neurosci

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Early onset scoliosis (EOS) is deformity of the spine below the age of 5 years. Children with EOS are at risk of impaired thoracic cage development and pulmonary maturation. Initial evaluation consists of determining the etiological cause for EOS, i.e., congenital, neurogenic, idiopathic, or syndromic. The advent of magnetic resonance imaging in recent times has lead to increased awareness of neurogenic causes leading to EOS. Evaluation of spinal cord anomalies in EOS is very important as early diagnosis and treatment can help in deformity stabilization and regression. Also, any surgical or nonsurgical intervention to correct the deformity without prior treatment of spinal cord anomalies can lead to disastrous neurological complications.

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Vertical expandable prosthetic titanium ribs (VEPTR) in early-onset scoliosis: Impact on thoracic compliance and sagittal balance

Cited by 9 publications

References 16 publications

Evolution of the postoperative sagittal spinal profile in early-onset scoliosis: is there a difference between rib-based and spine-based growth-friendly instrumentation?

Evolution of the postoperative sagittal spinal profile in early-onset scoliosis: is there a difference between rib-based and spine-based growth-friendly instrumentation?

Early Childhood Scoliosis Management by Vertical Expandable Prosthetic Titanium Rib (VEPTR): Experience of Royal Medical Services (RMS)

Intraspinal anomalies in early onset scoliosis: Current concepts

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