Abstract
IntroductionThough developed for thoracic insufficiency syndrome, the spinal growth-stimulating potential and the ease of placement of vertical expandable titanium ribs (VEPTRs) has resulted in their widespread use for early-onset spine deformity. Observation of implant-related ossifications warrants further assessment, since they may be detrimental to the function-preserving non-fusion strategy.Patients and methodsRadiographs (obtained pre and post index procedure, and at 4-year follow-up) and the records of 65 VEPTR patients from four paediatric spine centres were analysed. Ossifications were classified as type I (at anchor points), type II (along the central part) or type III (re-ossification after thoracostomy).ResultsThe average age at the index procedure was 6.5 years (min 1, max 13.7). The most prevalent spine problem was congenital scoliosis (37) with rib fusions (34), followed by neuromuscular and syndromic deformities (13 and 8, respectively). Idiopathic and secondary scoliosis (e.g. after thoracotomy) were less frequent (3 and 4, respectively). Forty-two of the 65 (65 %) patients showed ossifications, half of which were around the anchors. Forty-five percent (15/33) without pre-existing rib fusions developed a type II ossification along the implant. Re-ossifications of thoracostomies were less frequent (5/34, 15 %). The occurrence of ossifications was not associated with patient-specific factors.ConclusionsImplant-related ossifications around VEPTR are common. In contrast to harmless bone formation around anchors, ossifications around the telescopic part and the rod section are troublesome in view of their possible negative impact on chest cage compliance and spinal mobility. This potential side effect needs to be considered during implant selection, particularly in patients with originally normal thoracic and spinal anatomy.
Highlights
Though developed for thoracic insufficiency syndrome, the spinal growth-stimulating potential and the ease of placement of vertical expandable titanium ribs (VEPTRs) has resulted in their widespread use for earlyonset spine deformity
Vertical expandable prosthetic titanium ribs (VEPTRs) are mostly extraspinal implants that qualify as non-fusion procedures
Still controversial among spine surgeons, there is an emerging consensus that spine-based strategies are preferable for normally segmented spines, while VEPTR is the treatment of choice for congenital malformed spines and thoraces [33, 34]
Summary
Though developed for thoracic insufficiency syndrome, the spinal growth-stimulating potential and the ease of placement of vertical expandable titanium ribs (VEPTRs) has resulted in their widespread use for earlyonset spine deformity. J Child Orthop (2014) 8:237–244 deformity as well as the prevention of a negative change in the spinal biomechanics due to the immobilizing effect of the implant [3, 22]. The latter aim is reflected in the term ‘‘non-fusion’’. This descriptor is assigned to any growthsparing procedure in which there is believed to be an absence of autofusion, bridging ossifications and negative effects on the facet joints and the discs. In contrast to distractible spine-based constructs, such as growing rods or passive growth-guiding constructs (Luque or Shilla type), VEPTR is believed to overcome spinal autofusion [2, 19]
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