Abstract
PurposePatients who have neuromuscular scoliosis, such as cerebral palsy (CP), often develop spinal deformities that negatively impact quality of life. The vertical expandable prosthetic titanium rib (VEPTR) was designed for thoracic insufficiency syndrome (TIS), but it has also been utilized in patients with CP with restrictive lung disease and spine deformity. Few studies report on VEPTRs in neuromuscular scoliosis; however, none reports on their utilization specifically in patients with CP. Our purpose was to assess if VEPTRs can improve spinal deformity and TIS in these patients.MethodsA retrospective chart review was performed of all patients with CP and scoliosis treated with a VEPTR between 2008 and 2017. Eight patients were eligible for this study. The mean follow-up was four years. Outcomes evaluated were Cobb angle, pelvic obliquity, space available for lung ratio (SAL), T1-S1 height, and complication rates. A p-value of less than 0.05 was used for statistical significance.ResultsThere were significant postoperative improvements in Cobb angle, pelvic obliquity, and T1-S1 height, but no statistical difference in SAL. Prior to final fusion, the mean number of VEPTR lengthening procedures was 3. The mean time from index surgery to final fusion was 3.7 years. The most common complications were infection (62.5%) and wound dehiscence (25%). Only 25% of patients did not have a complication.ConclusionVEPTRs demonstrated significant improvement in almost all parameters and may be valuable in improving TIS in patients with CP. The complication and reoperation rates were similar to those of VEPTRs used for other pathological conditions.
Highlights
Early-onset scoliosis in patients who have cerebral palsy (CP) presents treatment challenges to pediatric orthopedic surgeons
Few studies report on vertical expandable prosthetic titanium rib (VEPTR) in neuromuscular scoliosis; none reports on their utilization in patients with CP
Patients were excluded if their neuromuscular scoliosis (NMS) etiology was not CP and if they had less than two years of follow-up after getting a VEPTR construct
Summary
Early-onset scoliosis in patients who have cerebral palsy (CP) presents treatment challenges to pediatric orthopedic surgeons. Some curves in children with CP tend to start at an earlier age and progress more rapidly, resulting in more severe deformities In these skeletally immature patients, non-operative options are often ineffective at slowing the progression of spinal deformity [1], and definitive spinal fusion at an early age may halt spine and thoracic cavity growth. In the early 2000s, Campbell et al introduced the use of rib-based distraction rods to treat complex spinal deformities that resulted in TIS [2,3] This system was named the vertical expandable prosthetic titanium rib (VEPTR) and was designed for skeletally immature patients with various degrees of impaired lung function who have or will likely soon develop TIS
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