Spinal deformity changes in children with long-term vertical expandable prosthetic titanium rib (VEPTR) treatment

Publication date: Available online 24 August 2017
Source:The Spine Journal
Author(s): Andrea S. Gantner, Lena Braunschweig, Konstantinos Tsaknakis, Heiko M. Lorenz, Anna K. Hell
Background ContextIn several studies, vertical expandable prosthetic titanium rib (VEPTR) implants have shown good scoliosis control in children with the longest reported follow-up (f/u) of 3.6 years. For growing rods, recent studies suggest a decreased efficiency of correction starting just after that time. To our knowledge, no long-term results of children with VEPTR treatment are available.PurposeTo evaluate spinal deformity in scoliotic children and to investigate correction potential of VEPTR implants at several time points of treatment, particularly after long-term f/u.Study Design/SettingRetrospective case series of 32 children with spinal deformity and VEPTR treatment with analysis of clinical and radiological data pre and post VEPTR implantation and every two years during the f/u period.Patient sample32 patients with spinal deformity and VEPTR treatment.Outcome measuresPatients had a primary VEPTR implantation due to spinal deformity and thoracic insufficiency syndrome and repeated lengthening procedures every six months. Clinical data were assessed and radiological parameters were analyzed. The main thoracic scoliotic curve and associated curves as well as kyphosis, lordosis, pelvic obliquity and spinal length were measured in all radiographs until the end of VEPTR treatment or the last available examination.MethodsDevelopment of the different parameters during f/u was evaluated and statistical analysis was performed with Statistica version 13.0. No funding was obtained for this study. The authors have no conflicts of interest to declare.ResultsDirectly after VEPTR implantation, thoracic and lumbar curves corrected significantly, were stable at 2.8 year f/u and increased at 5.5 year f/u, whereas cervical scoliosis was not affected by the treatment. The sagittal profile was initially improved both in kyphosis and lordosis. However, at 5.5 year f/u hyperkyphosis had deteriorated beyond the initial deformity. Pelvic obliquity was significantly restored especially in neuromuscular patients and increasing spinal length was achieved within the 5.5 year f/u.ConclusionIn children with spinal deformity, implantation of the VEPTR device sufficiently corrected the deformity in all planes. During long-term f/u scoliosis increased slightly and was rather well controlled, whereas the implant system was not able to prevent deterioration of hyperkyphosis. Pelvic obliquity was well balanced and spinal lengthening was achieved during long-term f/u.



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