Can VEPTR(®) control progression of early-onset kyphoscoliosis? A cohort study of VEPTR(®) patients with severe kyphoscoliosis.
BACKGROUND
Kyphoscoliosis is considered a relative contraindication to treatment with the Vertical Expandable Prosthetic Titanium Rib (VEPTR(®); Synthes Inc, Paoli, PA). Nevertheless, patients do present with early-onset kyphoscoliosis and thoracic insufficiency syndrome, and no suitable alternative treatments are currently available. However, it is unclear whether VEPTR(®) is reasonable for treating patients with kyphoscoliosis.


OBJECTIVE
We determined whether VEPTR(®) controls progression in patients with kyphoscoliosis and, if so, what methods might be used to improve control of deformity progression in these patients.


METHODS
We retrospectively reviewed 14 patients who had VEPTR(®) treatment of early-onset kyphoscoliosis. Degrees of kyphosis and scoliosis before, during, and after treatment were measured, and levels of instrumentation, thoracic dimensions, and complications were recorded. Minimum followup was 1.7 years (average, 5.8 years; range, 1.7-12.8 years).


RESULTS
While scoliosis was stabilized, kyphosis increased a mean of 22° at last followup. Supple kyphosis became rigid during treatment. Proximal cradle cutout was a recurring problem. Distal anchors placed too proximally had inadequate lever arms to control kyphosis.


CONCLUSIONS
Progression of kyphosis can be minimized during VEPTR(®) treatment by early extension of the construct to the second ribs bilaterally, distal extension of hybrid constructs to the pelvis, use of bilateral hybrid VEPTR(®) implants, and use of redesigned VEPTR(®) constructs that enhance fixation at the upper end. While our early results suggest these devices control progression of kyphosis, longer followup with more patients will be required to confirm the concept in these patients.
The Spinal and Thoracic Treatment and Research Center, Christus Santa Rosa Children's Hospital, 333 North Santa Rosa Street, San Antonio, TX 78207-3198, USA. kreinker@satx.rr.com
Kent
K
Reinker
James W
JW
Simmons
Vishwas
V
Patil
Zachary
Z
Stinson
D000367:Age Factors; D017668:Age of Onset; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D018450:Disease Progression; D006801:Humans; D007223:Infant; D007738:Kyphosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D008168:Lung / Q000503:physiopathology; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000295:instrumentation*; D011474:Prosthesis Design; D011859:Radiography; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D012272:Ribs / Q000000981:diagnostic imaging / Q000254:growth & development / Q000601:surgery*; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D012720:Severity of Illness Index; D013131:Spine / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000254:growth & development / Q000601:surgery*; D013781:Texas; D019616:Thoracic Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation*; D013997:Time Factors; D014025:Titanium; D016896:Treatment Outcome; D055815:Young Adult
D014025:Titanium