The usefulness of VEPTR in the older child with complex spine and chest deformity.
The vertical expandable prosthetic titanium rib (VEPTR) was originally designed to treat chest and spine deformities in young children. However, older children with complex spinal deformities may also benefit from placement of a VEPTR when vertebral column resections are deemed too risky neurologically. We report: (1) the changes in Cobb angle, T1 angle, and head tilt; and (2) the occurrence of complications in children older than 10 years of age treated with VEPTR. From a database of 214 patients treated in a Food and Drug Administration Investigational Device Exemption study of VEPTR, we identified 10 patients with assorted diagnoses who underwent surgery after age 10 and had a minimum of 24-month followup (mean, 39.6 months; range, 24-75 months). No patient sustained neurologic injury. Patients underwent an average of five lengthenings. The mean preoperative Cobb angle was 64.7 degrees and improved to 48.4 degrees. Head shift improved an average of 3.8 cm. Two device-related complications occurred (both in the same patient). Four patients have since undergone definitive spinal fusion. For a select group of patients 10 years of age or older, the VEPTR offers a reasonable alternative to potentially risky vertebral column resections for correcting deformities in selected patients.


METHODS
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Samdani
Amer F
AF
Shriners Hospital for Children, 3551 North Broad Street, Philadelphia, PA 19140, USA. asamdani@shrinenet.org
St Hilaire
Tricia
T
Emans
John B
JB
Smith
John T
JT
Song
Kit
K
Campbell
Robert J
RJ
Betz
Randal R
RR
D000015:Abnormalities, Multiple / Q000601:surgery*; D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008591:Meningomyelocele / Q000601:surgery*; D019736:Prostheses and Implants; D011474:Prosthesis Design; D012189:Retrospective Studies; D012272:Ribs / Q000002:abnormalities / Q000601:surgery*; D012600:Scoliosis / Q000151:congenital / Q000601:surgery*; D013123:Spinal Fusion; D035441:Thoracic Wall / Q000002:abnormalities / Q000601:surgery*; D014025:Titanium
D014025:Titanium