Bilateral rib-to-pelvis technique for managing early-onset scoliosis.
BACKGROUND
Early-onset scoliosis describes progressive spinal deformity of varying etiologies in the growing child. The management of early-onset scoliosis is challenging, with many treatment options but no conclusive evidence for the best treatment method.


OBJECTIVE
We describe a bilateral percutaneous rib-to-pelvis technique, present our early experience with this technique in patients with early-onset scoliosis, identify adverse events, and determine whether these are comparable to those for other current techniques.


METHODS
The VEPTR(®) device is placed through three small incisions that allow for attachment of rib hooks bilaterally at the upper end and through pelvic hooks at the distal end, providing distraction forces to correct the deformity while allowing for growth.


METHODS
We retrospectively reviewed all 37 patients with early-onset scoliosis treated with the bilateral rib-to-pelvis VEPTR(®) technique from 2003 and 2009. Patients were evaluated for demographics, diagnosis, curve correction, and adverse events and divided into two groups: ambulatory and nonambulatory. The 18 ambulatory patients underwent 139 procedures and the 19 nonambulatory patients underwent 100 procedures. Average followups were 84 and 64 months in the ambulatory and nonambulatory groups, respectively.


RESULTS
The rate of adverse events per procedure was 13%. Thirty-nine percent of ambulatory patients developed a marked crouched gait over time. The rate of adverse events in the nonambulatory group was 15%.


CONCLUSIONS
This technique appears a reasonable alternative to growing rods for the management of early-onset scoliosis in nonambulatory children due to the low rate of adverse events. Due to the increased incidence of crouched gait, we have abandoned this technique in ambulatory children unless there is no option to attach the distal fixation to the spine.
Department of Orthopaedics, University of Utah, University of Utah Orthopaedic Center, 590 Wakara Room A0058, Salt Lake City, UT 84113, USA. John.Smith@hsc.utah.edu
John T
JT
Smith
D000367:Age Factors; D017668:Age of Onset; D002648:Child; D002675:Child, Preschool; D005260:Female; D005684:Gait; D006801:Humans; D007223:Infant; D008297:Male; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000295:instrumentation; D018579:Patient Selection; D010384:Pelvic Bones / Q000000981:diagnostic imaging / Q000254:growth & development / Q000601:surgery*; D011474:Prosthesis Design; D011859:Radiography; D012189:Retrospective Studies; D012272:Ribs / Q000000981:diagnostic imaging / Q000254:growth & development / Q000601:surgery*; D018570:Risk Assessment; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D013131:Spine / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000254:growth & development / Q000601:surgery*; D019616:Thoracic Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation; D013997:Time Factors; D014025:Titanium; D016896:Treatment Outcome; D014589:Utah; D016138:Walking
D014025:Titanium