Abstract
ABSTRACT Objective: Traditional surgical treatments, such as on-site fusion and hemiepiphysiodesis, have not addressed chest deformity in its three dimensions, and are usually insufficient and unpredictable for the management of congenital and neuromuscular scoliosis. The application of the Vertical Expandable Prosthetic Titanium Rib (VEPTR) is a technique developed to treat early-onset progressive scoliosis that elongates the spine and thoracic wall, allowing adequate lung development. Methods: A case series retrospective study was conducted. We included 23 patients, including fifteen females and eight males diagnosed with congenital and neuromuscular scoliosis, who were treated with VEPTR type implants between January 2008 and May 2014. We obtained data about the implant and pre and postoperative radiographic images to assess the magnitude of the curve, and we measured the Cobb angle and length after lengthening, as well as evaluating the complications found. Results: There was an improvement in the postoperative Cobb angle. In patients with congenital scoliosis, deformity correction was 8.6% (p=0.014), and in neuromuscular scoliosis, we observed deformity correction of 19.5% (p=0.009). Likewise, we found gains in thoracic height through the device, which results in an average 10% lengthening of the spine in congenital scoliosis. In this study, we identified complications such as material migrations, rib synostosis, pressure zones, rib fracture, hemothorax, and deep wound infection. Conclusion: The natural history of progressive spinal deformity was improved in most of the minors, through the use of VEPTR. This allows us to continue managing patients in the future, in order to make a deeper assessment of its performance in treatment of early onset scoliosis. Level of Evidence III; Therapeutic studies - Investigating the results of a treatment.
Highlights
There are multiple methods for the management of congenital and neuromuscular scoliosis in underage patients.[1]
Based on the effective results of the Vertical Expandable Prosthetic Titanium Rib (VEPTR),[8] we have designed a series of cases to investigate the clinical and radiological outcomes of the VEPTR system in the management of spinal deformities in patients at the Instituto de Ortopedia Infantil Roosevelt
For patients with congenital scoliosis, the average preoperative Cobb angle was 51.12° ± 13.74 degrees, and the mean postoperative Cobb angle was 46.70° ± 11.83 degrees, demonstrating a reduction in the magnitude of the deformity of 8.6%, which is statistically significant (p=0.014); we found significant lengthening of the spine, measured through the system, with a preoperative length of 183.80 ± 53.90 mm, and a postoperative length of 203.87 ± 57.18 mm, demonstrating a 10% (p=0.002) gain in spinal length
Summary
There are multiple methods for the management of congenital and neuromuscular scoliosis in underage patients.[1] Traditional surgical treatments, such as on-site fusion and hemiepiphysiodesis, have not addressed chest deformity in its three dimensions, and are usually insufficient and unpredictable; likewise, arthrodesis hinders the axial growth of the thoracic spine and proper lung development. Based on the effective results of the VEPTR,[8] we have designed a series of cases to investigate the clinical and radiological outcomes of the VEPTR system in the management of spinal deformities in patients at the Instituto de Ortopedia Infantil Roosevelt This technique directly treats thoracic insufficiency syndrome, and the related vertebral anomalies.[2,3] The purpose of this management is to lengthening the constrained thorax wall to provide more space for the developing lungs, allow secondary thoracic growth, and prevent the progression of the scoliotic deformity.[4,5,6]
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