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Observational Study
. 2020 Jul;40(6):e406-e412.
doi: 10.1097/BPO.0000000000001454.

VEPTR Treatment of Early Onset Scoliosis in Children Without Rib Abnormalities: Long-term Results of a Prospective, Multicenter Study

Ron El-Hawary  1 , Kevin Morash  1 , Muayad Kadhim  1 , Michael Vitale  2 , John Smith  3 , Amer Samdani  4 , John Flynn  5 ; Children’s Spine Study Group
Affiliations
Observational Study

VEPTR Treatment of Early Onset Scoliosis in Children Without Rib Abnormalities: Long-term Results of a Prospective, Multicenter Study

Ron El-Hawary et al. J Pediatr Orthop. 2020 Jul.

Abstract

Background: In 2007, this prospective study on vertical expandable prosthetic titanium rib (VEPTR) treatment of early onset scoliosis in children without rib abnormalities was initiated. Two-year follow-up results have previously been reported. This study examines whether, at 5-year follow-up, VEPTR continues to control scoliosis and allow spinal growth.

Methods: A prospective, multicenter, observational cohort design was used. Patients underwent traditional VEPTR implantation ≥5 years before analysis. Preimplantation and last available images were compared, regardless of whether VEPTR remained in vivo. Additional analysis was performed if VEPTR was in vivo ≥5 years.

Results: This study included 59 patients (mean age at VEPTR implantation, 6.1±2.4 y; mean follow-up, 6.9±1.4 y). Currently, 24 patients still have VEPTR, whereas 24 have converted (13 fusions, 6 MCGR, 3 growing rods, 1 hybrid, and 1 Shilla). Three have had VEPTR explanted, 6 are unknown, and 2 have deceased. On last available imaging (n=59; mean follow-up, 4.8±1.9 y), scoliosis improved from 71.8±18.0 degrees preoperatively to 60.9±20.3 degrees (P<0.001) and T1- T12 height increased (15.8±3.2 to 19.3±3.8 cm, P<0.001). T1-S1 height also increased (24.8±4.4 to 31.2±5.3 cm, P<0.001), representing 119% age-matched growth. Composite improvement of scoliosis, T1-T12, and T1-S1 height was achieved in 79% of patients. A subset of 29 patients with VEPTR was analyzed at most recent follow-up ≥5 years while VEPTR remained in vivo (24 patients with VEPTR above, and 5 who later converted to other devices). Mean age at implantation was 5.0±2.2 years, with a mean VEPTR treatment duration of 6.2±1.1 years. Scoliosis improved from preoperatively (69.3±14.5 to 61.6±16.1 degrees, P=0.006), with mild recurrence from postoperative to 5 years. T1-T12 height increased (15.0±3.3 to 18.7±3.3 cm, P<0.001) and T1-S1 height increased (23.7±4.5 to 30.1±4.6 cm, P<0.001), representing 83% age-matched growth. Composite improvement was achieved in 83% of patients. Instrumented sagittal length also increased during this period (21.8±4.2 to 30.3±5.1 cm, P<0.001).

Conclusion: At a 5-year follow-up, VEPTR continues to control scoliosis and allow spinal growth.

Level of evidence: Level II-prospective cohort, therapeutic study.

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References

    1. El-Hawary R, Akbarnia BA. Early onset scoliosis—time for consensus. Spine Deform. 2015;3:105–106.
    1. El-Hawary R, Kadhim M, Vitale M, et al. VEPTR implantation to treat children with early onset scoliosis without rib abnormalities: early results from a prospective multicenter study. J Pediatr Orthop. 2017;37:e599–e605.
    1. Skaggs DL, Guillaume T, El-Hawary R, et al. Early onset scoliosis consensus statement, SRS growing spine committee. Spine Deform. 2015;3:107.
    1. Williams BA, Matsumoto H, McCalla DJ, et al. Development and initial validation of the Classification of Early-Onset Scoliosis (C-EOS). J Bone Joint Surg Am. 2014;96:1359–1367.
    1. Canavese F, Dimeglio A. Normal and abnormal spine and thoracic cage development. World J Orthop. 2013;4:167–174.

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