title: Use of Vertical Expandable Prosthetic Titanium Rib (VEPTR) in the Treatment of Congenital Scoliosis Without Fused Ribs.
abstract: BACKGROUND
  Although the vertical expandable prosthetic titanium rib (VEPTR) has been shown to be useful in treating congenital scoliosis (CS) with fused ribs, no studies to date have specifically evaluated the efficacy of VEPTR in the treatment of CS without fused ribs. The purpose of this study was to determine the effectiveness of VEPTR in sagittal/coronal curve correction and spine growth and compare its complication rate to the use of VEPTR in other conditions and to other treatment methods used for CS.
  
  
  METHODS
  A multicenter database was queried for patients with CS without fused ribs treated with VEPTR. Anteroposterior (AP) and lateral radiographs were used to measure parameters at 3 timepoints (preoperative, immediate postoperative, and latest follow-up): coronal Cobb angle, sagittal kyphosis, and thoracic and lumbar spine heights. Clinical data included age, time to follow-up, and complications.
  
  
  RESULTS
  Twenty-five patients (13 females, 12 males) were identified. The average age at implantation was 5.7 years, with an average follow-up of 50 months. Several parameters improved from preoperative to latest follow-up: coronal Cobb angle (69 to 54 degrees, P<0.0001), thoracic spine height (T1-T12) in the AP (13.3 to 15.9 cm, P<0.0001) and lateral (14.8 to 17.4 cm, P=0.0024) planes, and lumbar spine height (L1-S1) in the AP (8.8 to 11.4 cm, P<0.0001) and lateral (9.9 to 11.9 cm, P=0.0002) planes. Kyphosis increased over the study period (36 to 41 degrees, P=0.6). Fifteen patients (60%) had 41 complications (average 2.75; range, 1 to 12). Twenty-eight complications (68%) were device-related, and 13 (32%) were disease-related. The most common complications were infection, wound dehiscence, and device migration. Six complications (15%) altered the course of treatment. Thoracic spine height increased 79% of expected growth.
  
  
  CONCLUSIONS
  VEPTR is an effective treatment for patients with CS without fused ribs, as evidenced by improved radiographic parameters and increased spinal height, with a complication rate which is high but similar to other methods of treatment.
  
  
  METHODS
  Level IV-case series.
authors.affiliation: *Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee-Campbell Clinic †Le Bonheur Children's Hospital ‡Departments of Pediatrics and Preventive Medicine, University of Tennessee, Memphis, TN.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Murphy
authors.forename: Alice
authors.initials: A
authors.lastname: Moisan
authors.forename: Derek M
authors.initials: DM
authors.lastname: Kelly
authors.forename: William C
authors.initials: WC
authors.lastname: Warner
authors.forename: Tamekia L
authors.initials: TL
authors.lastname: Jones
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Sawyer
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007223:Infant; D007738:Kyphosis; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D019637:Orthopedic Procedures; D019736:Prostheses and Implants; D011474:Prosthesis Design; D011859:Radiography; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D012272:Ribs / Q000000981:diagnostic imaging / Q000601:surgery*; D012600:Scoliosis / Q000151:congenital / Q000000981:diagnostic imaging / Q000601:surgery*; D012720:Severity of Illness Index; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D014025:Titanium; D016896:Treatment Outcome
chemical_list: D014025:Titanium