The usefulness of VEPTR in the older child with complex spine and chest deformity

Abstract

The vertical expandable prosthetic titanium rib (VEPTR) was originally designed to treat chest and spine deformities in young children. However, older children with complex spinal deformities may also benefit from placement of a VEPTR when vertebral column resections are deemed too risky neurologically. We report: (1) the changes in Cobb angle, T1 angle, and head tilt; and (2) the occurrence of complications in children older than 10 years of age treated with VEPTR. From a database of 214 patients treated in a Food and Drug Administration Investigational Device Exemption study of VEPTR, we identified 10 patients with assorted diagnoses who underwent surgery after age 10 and had a minimum of 24-month followup (mean, 39.6 months; range, 24-75 months). No patient sustained neurologic injury. Patients underwent an average of five lengthenings. The mean preoperative Cobb angle was 64.7 degrees and improved to 48.4 degrees. Head shift improved an average of 3.8 cm. Two device-related complications occurred (both in the same patient). Four patients have since undergone definitive spinal fusion. For a select group of patients 10 years of age or older, the VEPTR offers a reasonable alternative to potentially risky vertebral column resections for correcting deformities in selected patients.

Level of evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Fig. 1A–F

(A, B) A 13-year-old girl presented with congenital scoliosis and fused ribs with a convex left high thoracic curvature measuring 86°. She underwent rib-to-spine and rib-to-rib VEPTR placement with multiple opening wedge thoracostomies. (C) Three-month postoperative anteroposterior and (D) lateral radiographs demonstrate curve correction to 58°. (E, F) Six years and two routine expansions later, she continues to do well with her curve maintained at 55°.