title: VEPTR™ growing rods for early-onset neuromuscular scoliosis: feasible and effective.
abstract: BACKGROUND
  The Vertical Expandable Prosthetic Titanium Rib (VEPTR™; Synthes North America, West Chester, PA) reportedly controls spinal deformity associated with constrictive chest wall conditions.
  
  
  OBJECTIVE
  We asked whether spine-to-spine constructs using VEPTR™ instrumentation in combination with standard spinal instrumentation could be deployed to salvage failed rib-to-spine constructs used originally in patients with constricted chest walls and to primarily treat progressive spinal deformity without chest wall abnormalities.
  
  
  METHODS
  Fifty patients were treated with VEPTR™ constructs for thoracic insufficiency syndrome at our center between 2001 and 2007. Fourteen of these 50 patients had placement of a spine-to-spine construct using a VEPTR™ implant in combination with standard spinal implants and are the subject of this retrospective review. Five had prior rib-based VEPTR™ or growing implants with an average of two failures before this surgery. Radiographic variables, preceding treatment, complications, and changes in ambulatory status, were recorded. The minimum followup was 2 years (mean, 35 months; range, 2-4 years).
  
  
  RESULTS
  After an average of five expansions in these 14 patients, positive changes were recorded for Cobb angle, T1-S1 height, sagittal balance, and space available for the lung. Complications included two rod fractures, two superficial infections, and one deep infection with rod removal.
  
  
  CONCLUSIONS
  VEPTR™ instrumentation as a spine-to-spine growing-rod construct demonstrated ease of implantation and expansion, with complication rates similar to other reported devices. This study suggests growing constructs using VEPTR™ can be used with relatively few complications and extends the potential uses of this instrumentation system.
authors.affiliation: Department of Orthopedic Surgery, Seattle Children's Hospital, 4800 Sand Point Way, W-7706, Seattle, WA 98105, USA.
authors.forename: Klane K
authors.initials: KK
authors.lastname: White
authors.forename: Kit M
authors.initials: KM
authors.lastname: Song
authors.forename: Nathan
authors.initials: N
authors.lastname: Frost
authors.forename: Brian K
authors.initials: BK
authors.lastname: Daines
mesh_terms: D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000295:instrumentation*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000209:etiology; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D012272:Ribs / Q000254:growth & development / Q000601:surgery*; D012600:Scoliosis / Q000000981:diagnostic imaging / 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; D014861:Washington
chemical_list: D014025:Titanium