title: Complications in pediatric spine surgery using the vertical expandable prosthetic titanium rib: the French experience.
abstract: METHODS
  Multicenter retrospective study of 54 children.
  
  
  OBJECTIVE
  To describe the complication rate of the French vertical expandable prosthetic titanium rib (VEPTR) series involving patients treated between August 2005 and January 2012.
  
  
  BACKGROUND
  Congenital chest wall and spine deformities in children are complex entities. Most of the affected patients have severe scoliosis often associated with a thoracic deformity. Orthopedic treatment is generally ineffective, and surgical treatment is very challenging. These patients are good candidates for VEPTR expansion thoracoplasty. The aim of this study was to evaluate the potential complications of VEPTR surgery.
  
  
  METHODS
  Of the 58 case files, 54 were available for analysis. The series involved 33 girls and 21 boys with a mean age of 7 years (range, 20 mo-14 yr and 2 mo) at primary VEPTR surgery. During the follow-up period, several complications occurred.
  
  
  RESULTS
  Mean follow-up was 22.5 months (range, 6-64 mo). In total, 184 procedures were performed, including 56 VEPTR implantations, 98 expansions, and 30 nonscheduled procedures for different types of complications: mechanical complications (i.e., fracture, device migration), device-related and infectious complications, neurological disorders, spine statics disturbances. Altogether, there were 74 complications in 54 patients: a complication rate of 137% per patient and 40% per surgery. Comparison of the complications in this series with those reported in the literature led the authors to suggest solutions that should help decrease their incidence.
  
  
  CONCLUSIONS
  The complication rate is consistent with that reported in the literature. Correct determination of the levels to be instrumented, preoperative improvement of nutritional status, and better evaluation of the preoperative and postoperative respiratory function are important factors in minimizing the potential complications of a technique that is used in weak patients with complex deformities.
authors.affiliation: *Department of Pediatric Orthopaedic Surgery, Hôpital Sud, Rennes, France †Department of Pediatric Orthopaedic Surgery, Hôpital La Timone, Marseille, France ‡Department of Pediatric Orthopaedic Surgery, Hôpital Purpan Enfants, Toulouse, France §Department of Pediatric Orthopaedic Surgery, Hôpital d'enfants, Vandoeuvre lès Nancy, France ¶Department of Pediatric Orthopaedic Surgery, Hôpital Hautepierre, Strasbourg, Germany ‖Department of Pediatric Orthopaedic Surgery, CHU de Caen, Caen, France **Department of Pediatric Orthopaedic Surgery, Hôpital Morvan, Brest, France ††Department of Pediatric Orthopaedic Surgery, CHU de Montpellier, Montpellier, France ‡‡Department of Pediatric Orthopaedic Surgery, CHU de Besançon, Besançon, France; and §§Department of Pediatric Orthopaedic Surgery, CHU de Lille, Lille, France.
authors.forename: Grégory
authors.initials: G
authors.lastname: Lucas
authors.forename: Gérard
authors.initials: G
authors.lastname: Bollini
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Jouve
authors.forename: Jérome Sales
authors.initials: JS
authors.lastname: de Gauzy
authors.forename: Franck
authors.initials: F
authors.lastname: Accadbled
authors.forename: Pierre
authors.initials: P
authors.lastname: Lascombes
authors.forename: Pierre
authors.initials: P
authors.lastname: Journeau
authors.forename: Claude
authors.initials: C
authors.lastname: Karger
authors.forename: Jean François
authors.initials: JF
authors.lastname: Mallet
authors.forename: Petre
authors.initials: P
authors.lastname: Neagoe
authors.forename: Jérome
authors.initials: J
authors.lastname: Cottalorda
authors.forename: Benoit
authors.initials: B
authors.lastname: De Billy
authors.forename: Jean
authors.initials: J
authors.lastname: Langlais
authors.forename: Bernard
authors.initials: B
authors.lastname: Herbaux
authors.forename: Damien
authors.initials: D
authors.lastname: Fron
authors.forename: Philippe
authors.initials: P
authors.lastname: Violas
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010372:Pediatrics; D011183:Postoperative Complications / Q000145:classification / Q000209:etiology; D019736:Prostheses and Implants / Q000009:adverse effects*; D012189:Retrospective Studies; D012272:Ribs / Q000601:surgery*; D012600:Scoliosis / Q000151:congenital / Q000601:surgery; D013131:Spine / Q000002:abnormalities / Q000473:pathology / Q000601:surgery*; D035441:Thoracic Wall / Q000601:surgery*; D013905:Thoracoplasty / Q000379:methods; D014025:Titanium; D016896:Treatment Outcome
chemical_list: D014025:Titanium