Abstract
Introduction: In congenital anomalies of the thoracic spine, fusion in situ and hemi-epiphysiodesis are unsuitable surgical options, because three-dimensional thoracic deformity and insufficiency are uncorrectable. We aimed to evaluate the radiological outcome of vertical expandable titanium rib (VEPTR) application after follow-up in children with congenital scoliosis with or without rib fusion.Methods: In our study, we included 58 patients with congenital scoliosis with or without fused ribs; all treated with VEPTR from 2005 to 2015 at our institute. There were 19 males and 39 females. For each patient, we collected information about age at the index surgery (VEPTR application) and the total number of VEPTR lengthening procedures. Also, Cobb angle, kyphotic angle, thoracic height, and spinal height were measured on preoperative radiographs, immediately post-operative, two years post-operative, and at final follow-up.Results: The mean duration of follow-up was five years (range, 2-12 years). Twenty-eight patients had rib-to-pelvis type VEPTR, 20 patients had rib-to-rib type VEPTR, and 10 patients had a rib to pedicle/lamina type of VEPTR implant. Post-VEPTR, 63.8% of our patients reported one or more complications. The immediate post-VEPTR application showed that the mean Cobb angle decreased to 43.56° with a percentage change of 22.8% (p<0.001). The mean increase in thoracic height between VEPTR application surgery and final follow-up was 32 mm with a 19.3% increase (p<0.001). Similarly, the mean increase in the spinal height between the VEPTR application surgery and final follow-up was 46.6 mm, with a 23% increase (p<0.001).Conclusions: VEPTR instrumentation for congenital scoliosis, with or without rib fusion, successfully corrects the coronal Cobb angle in the majority of patients. It also allows the thoracic (T1-T12) and spinal (T1-S1) growth to approach normal for a particular age.
Highlights
In congenital anomalies of the thoracic spine, fusion in situ and hemi-epiphysiodesis are unsuitable surgical options, because three-dimensional thoracic deformity and insufficiency are uncorrectable
The vertical expandable titanium rib (VEPTR) was established by Campbell et al during the 1990s to manage thoracic insufficiency syndrome (TIS); they challenged the notion that guided or forced growth management of congenital scoliosis deformities which could not be done in congenital abnormalities with the use of rib-based systems using the VEPTR [1,4]
Patients with any spinal surgery before the index VEPTR procedure were excluded; and we focused on 58 patients with congenital scoliosis with or without fused ribs
Summary
In congenital anomalies of the thoracic spine, fusion in situ and hemi-epiphysiodesis are unsuitable surgical options, because three-dimensional thoracic deformity and insufficiency are uncorrectable. We aimed to evaluate the radiological outcome of vertical expandable titanium rib (VEPTR) application after follow-up in children with congenital scoliosis with or without rib fusion. Congenital scoliosis represents an abnormal spinal curvature caused by failure of vertebral formation and/or segmentation associated with fused ribs [1]. Vertical expandable titanium rib (VEPTR) implantation may be considered to treat thoracic insufficiency syndrome (TIS) associated with congenital scoliosis, Jeune syndrome, and Jarcho-Levin syndrome [3]. The VEPTR was established by Campbell et al during the 1990s to manage TIS; they challenged the notion that guided or forced growth management of congenital scoliosis deformities which could not be done in congenital abnormalities with the use of rib-based systems using the VEPTR [1,4]. Progression of scoliosis is preventable, and thoracic growth is allowed [2]
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