Treatment of congenital scoliosis with the vertical expandable prosthetic titanium rib implant

Abstract

Children with congenital thoracic scoliosis associated with fused ribs and unilateral unsegmented bars adjacent to convex hemivertebrae will invariably have curve progression without treatment. It is assumed that the unilateral unsegmented bars do not grow and therefore early spinal fusion has been performed in the past with consecutive short thoracic spines and loss of lung volume. A new surgical technique is based on an indirect deformity correction and enlargement of the thorax via a longitudinal implant, the vertical expandable prosthetic titanium rib (VEPTR). The length of the thoracic spine after VEPTR implantation was analyzed in 21 children with an average follow-up of 4.2 years. Eighteen children did not have any prior surgery while three had already undergone spinal fusion. Using a 3-D analysis of computed tomography, a significant growth of the concave (7.9 mm/7.1% increase per year) and convex (8.3 mm/6.4%) side of the thoracic spine was found with no significant difference between sides. Unilateral unsegmented bars showed significant growth as well. Contrary to common knowledge, we were able to demonstrate the growth of the concave side of the thoracic spine and of the unilateral unsegmented bars after expansion thoracoplasty and VEPTR implantation.