Evaluation of the VEPTR (Vertical Expandable Prosthetic Titanium Rib) Device in the Treatment of Patients with Congenital and Neuromuscular Spinal Deformities

Abstract

Introduction Multiple methods are included in the management of congenital, neuromuscular, or idiopathic scoliosis in younger patients. The traditional surgical treatments, such as, in situ fusion and hemiepiphysiodesis have not addressed the thoracic deformity in three dimensions, and the results are usually insufficient and unpredictable. The objective of the VEPTR management is focused on the chest wall extensions, to provide more space for the developing lungs, and prevents progression of the scoliotic deformity. From results of studies on the effectiveness of patients with VEPTR within early onset scoliosis, we designed a retrospective case series study for clinical and radiological outcomes of VEPTR system in the management of patients with spinal deformities in congenital and neuromuscular scoliosis. Patients and Methods This is a retrospective case series study. A total of 23 patients, 15 women and 8 men, with congenital and neuromuscular scoliosis, treated with VEPTR implantation, from January 2008 to May 2014 were included. The average age for the initial insertion of VEPTR was 5 years (range, 8 months–12 years), with an average follow-up time of 26 months. Specific data for the construction of the implant were collected; the pre- and postoperative X-rays were measured by the Cobb method to evaluate the magnitude of the curve, and the total length of the system in the coronal plane before insertion of the VEPTR device, and after each elongation were measured. In addition, complications such as infection, failure of material, pressure zones, synostosis, and hemothorax were evaluated. Results Our results demonstrated that there was an improvement in the postoperative Cobb angle measurement in the coronal plane. In children with congenital scoliosis, the average correction was 13% ( p < 0.001) and in neuromuscular scoliosis was an average correction of 22% ( p < 0.001). Likewise, there was an increase of the thoracic length measured through the VEPTR device, developing an average elongation of 9% of the column in children with congenital scoliosis and 18% in children with neuromuscular scoliosis. In this study, complications such as device migration, costal synostosis, pressure injuries, rib fractures, hemothorax, and deep infection were identified. Conclusion The data analysis shows that the natural history of progressive spinal deformities in children with congenital and neuromuscular scoliosis was satisfactorily controlled by using the VEPTR device. This allows us to recommend the use of this implant and continue using it in the treatment of patients with these deformities.