title: [Early outcome of vertical expandable prosthetic titanium rib technique in treating early-onset scoliosis].
abstract: OBJECTIVE
  To investigate the early outcome of vertical expandable prosthetic titanium rib (VEPTR) technique in treating early-onset scoliosis.
  
  
  METHODS
  This study recruited 11 early-onset scoliosis patients (8 boys and 3 girls) who received VEPTR treatment from December 2006 to July 2011 with a minimum follow-up of 12 months. The average age at initial surgery was (7 ± 3) years (range, 3.1 to 9.8 years). VEPTR device, either rib to rib or rib to lumbar, was implanted at initial surgery. During the regular post-operative follow-ups, expansion surgeries were scheduled at an interval of 6 to 12 months. Measurements of primary curve magnitude, apical vertebral translation, thoracic height and T(1)-S(1) height were performed on radiographs, and were compared between those of preoperatively, postoperatively, and at latest follow-up through paired-t tests.
  
  
  RESULTS
  All patients had a mean follow-up of (32 ± 11) months. Totally 41 surgeries were performed, averagely 3.7 surgeries per patient; and 30 expansion surgeries were carried out, averagely 2.7 surgeries per patient. The average interval for each expansion surgery was 8 months. From preoperatively to latest follow-up, the Cobb angle of primary curves was averagely corrected from 78° ± 18° to 55° ± 11° (t = 4.931, P < 0.05), and apical vertebral translation and thoracic kyphosis displayed slight improvement. Average thoracic height increased from (13.3 ± 2.0) cm to (17.2 ± 2.4) cm (t = 8.365, P < 0.001), and average T(1)-S(1) height from (24.4 ± 3.8) cm to (32.5 ± 5.3) cm (t = 9.080, P < 0.001). After initial surgery with VEPTR instrumented, gains in thoracic height and T(1)-S(1) height per expansion surgery averaged (0.8 ± 0.3) cm and (1.8 ± 0.4) cm, respectively. Eight complications occurred in 6 patients, including rib cradle dislodgements, displayed infection, intraoperative pleura rupture and loosening of lumbar pedicle screws.
  
  
  CONCLUSIONS
  VEPTR technique proves to be an effective way of preventing curve progression in early-onset scoliosis patients while allowing growth of spine and chest. Yet, indications for such a technique need to be strictly selected because of the relatively high complication rate.
authors.affiliation: Department of Spine Surgery, Nanjing University, Nanjing, China. scoliosis2002@sina.com
authors.forename: Yong
authors.initials: Y
authors.lastname: Qiu
authors.forename: Xu
authors.initials: X
authors.lastname: Sun
authors.forename: Bin
authors.initials: B
authors.lastname: Wang
authors.forename: Qi
authors.initials: Q
authors.lastname: Ding
authors.forename: Ze-zhang
authors.initials: ZZ
authors.lastname: Zhu
authors.forename: Bang-ping
authors.initials: BP
authors.lastname: Qian
authors.forename: Yang
authors.initials: Y
authors.lastname: Yu
authors.forename: Feng
authors.initials: F
authors.lastname: Zhu
authors.forename: Wei-wei
authors.initials: WW
authors.lastname: Ma
mesh_terms: D017668:Age of Onset; D018786:Bone Substitutes / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D012272:Ribs; D012600:Scoliosis / Q000601:surgery*; D013131:Spine / Q000033:anatomy & histology* / Q000601:surgery*; D014025:Titanium; D016896:Treatment Outcome
chemical_list: D018786:Bone Substitutes; D014025:Titanium