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. 2011 May;469(5):1342-8.
doi: 10.1007/s11999-010-1697-6.

Can VEPTR(®) control progression of early-onset kyphoscoliosis? A cohort study of VEPTR(®) patients with severe kyphoscoliosis

Kent Reinker  1 , James W Simmons, Vishwas Patil, Zachary Stinson
Affiliations

Can VEPTR(®) control progression of early-onset kyphoscoliosis? A cohort study of VEPTR(®) patients with severe kyphoscoliosis

Kent Reinker et al. Clin Orthop Relat Res. 2011 May.

Abstract

Background: Kyphoscoliosis is considered a relative contraindication to treatment with the Vertical Expandable Prosthetic Titanium Rib (VEPTR(®); Synthes Inc, Paoli, PA). Nevertheless, patients do present with early-onset kyphoscoliosis and thoracic insufficiency syndrome, and no suitable alternative treatments are currently available. However, it is unclear whether VEPTR(®) is reasonable for treating patients with kyphoscoliosis.

Questions/purposes: We determined whether VEPTR(®) controls progression in patients with kyphoscoliosis and, if so, what methods might be used to improve control of deformity progression in these patients.

Patients and methods: We retrospectively reviewed 14 patients who had VEPTR(®) treatment of early-onset kyphoscoliosis. Degrees of kyphosis and scoliosis before, during, and after treatment were measured, and levels of instrumentation, thoracic dimensions, and complications were recorded. Minimum followup was 1.7 years (average, 5.8 years; range, 1.7-12.8 years).

Results: While scoliosis was stabilized, kyphosis increased a mean of 22° at last followup. Supple kyphosis became rigid during treatment. Proximal cradle cutout was a recurring problem. Distal anchors placed too proximally had inadequate lever arms to control kyphosis.

Conclusions: Progression of kyphosis can be minimized during VEPTR(®) treatment by early extension of the construct to the second ribs bilaterally, distal extension of hybrid constructs to the pelvis, use of bilateral hybrid VEPTR(®) implants, and use of redesigned VEPTR(®) constructs that enhance fixation at the upper end. While our early results suggest these devices control progression of kyphosis, longer followup with more patients will be required to confirm the concept in these patients.

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Figures

Fig. 1A–F
Fig. 1A–F
Initial (A) posteroanterior and (B) lateral radiographs of Patient 10 show severe scoliosis and kyphosis. (C) Scoliosis in Patient 10 has been improved by initial VEPTR® placement, (D) but kyphosis has worsened. (E) Addition of a hybrid VEPTR® extending to L5 has improved the kyphosis (F) but has resulted in some lateral decompensation.
Fig. 2A–D
Fig. 2A–D
Patient 12 has (A) a moderately severe scoliosis and (B) a supple 80° kyphosis before VEPTR® treatment. At latest followup, (C) Patient 12 has excellent control of scoliosis, (D) but his kyphosis has increased to 104°. The VEPTR® cradled at T2 has too proximal a distal seating to control the kyphosis and the two hybrid VEPTR® implants do not bridge the apex of kyphosis.
See this image and copyright information in PMC

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