Bilateral use of the vertical expandable prosthetic titanium rib attached to the pelvis: a novel treatment for scoliosis in the growing spine.
OBJECTIVE
Few options exist for the treatment of severe, early onset scoliosis. Goals of treatment include stabilizing curve progression while allowing for normal spine, chest, and lung growth. The vertical expandable prosthetic titanium rib (VEPTR) is a novel device designed to control the spine deformity while permitting lung and spine growth. In this paper the authors report their experience with using bilateral VEPTRs from the ribs to the pelvis for children with severe, early onset scoliosis.


METHODS
Eleven children were identified who had been treated with bilateral VEPTRs from the ribs to the pelvis. The authors conducted a retrospective review and collected the following data: clinical diagnosis, age at surgery, number of lengthening procedures, and complications. In addition, pre- and postoperative radiographs were reviewed to measure maximum Cobb angle (both thoracic and lumbar), thoracic height, total spine height as measured from T-1 to S-1, thoracic kyphosis (T2-12), and lumbar lordosis (L1-S1).


RESULTS
The average patient age at surgery was 71 months; the mean preoperative thoracic Cobb angle was 81.7 degrees . This angle was corrected to 50.6 degrees immediately postoperatively, and this correction was maintained; at the most recent follow-up the curves averaged 58 degrees . Similarly, the preoperative kyphosis (T2-12) angle measured 43 degrees preoperatively, 23 degrees immediately postoperatively, and 37 degrees at the most recent follow-up evaluation. The patients underwent a total of 41 lengthening procedures (average 3.7 lengthening procedures per patient), and overall spine length increased from 23.1 cm preoperatively, to 27.3 cm immediately postoperatively, to 29.4 cm at the final follow-up (an average of 25 months). Four (36.4%) of the 11 patients experienced complications.


CONCLUSIONS
The VEPTR offers a viable treatment option for children with severe, early onset scoliosis. It achieves and maintains spinal deformity correction, while allowing for continued spine and chest-wall growth. Complication rates are similar to those reported for other growing systems.
Shriners Hospital for Children, Philadelphia, Pennsylvania 19140, USA. amersamdani@yahoo.com
Amer F
AF
Samdani
Ashish
A
Ranade
Henry J
HJ
Dolch
Reed
R
Williams
Tricia
T
St Hilaire
Patrick
P
Cahill
Randal R
RR
Betz
D000293:Adolescent; D017668:Age of Onset; D002648:Child; D005260:Female; D006801:Humans; D007738:Kyphosis / Q000000981:diagnostic imaging / Q000601:surgery; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000254:growth & development; D008297:Male; D010388:Pelvis / Q000000981:diagnostic imaging / Q000254:growth & development / Q000601:surgery; D019736:Prostheses and Implants; D011474:Prosthesis Design; D011859:Radiography; D012189:Retrospective Studies; D012272:Ribs / Q000000981:diagnostic imaging / Q000254:growth & development / Q000601:surgery*; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000601:surgery*; D012720:Severity of Illness Index; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000254:growth & development; D035441:Thoracic Wall / Q000254:growth & development; D013907:Thoracostomy / Q000379:methods*; D014025:Titanium
D014025:Titanium