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The effect of vertical expandable prosthetic titanium rib on growth in congenital scoliosis.

Balioglu MB, Albayrak A, Akman YE, Atici Y, Kargin D, Kaygusuz MA - J Craniovertebr Junction Spine (2015 Oct-Dec)

Bottom Line: In our study, we evaluated the effect of VEPTR on growth in congenital scoliosis.Four female patients in whom VEPTR was applied were retrospectively evaluated.VEPTR may provide a good correction, and we observed a growth in the spine height and SAL following the treatment of congenital deformities.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics and Traumatology, Spine Surgery and Arthroplasty Clinic, Metin Sabanci Baltalimani Bone Disease Education and Research Hospital, Istanbul, Turkey.

ABSTRACT

Aims: In the treatment of thoracic insufficiency syndrome, the main aim is to maintain spinal and thoracic growth in order to continue respiratory functions. Vertical expandable prosthetic titanium rib (VEPTR) device application is a method of choice especially in the congenital cases with a thoracic deformity. In our study, we evaluated the effect of VEPTR on growth in congenital scoliosis.

Materials and methods: Four female patients in whom VEPTR was applied were retrospectively evaluated. Anteroposterior (AP) and lateral Cobb angles that were measured preoperatively and during the last control, space available for lung (SAL), T1-S1 and T1-T12 distances, coronal and sagittal balances were compared.

Results: Four female patients in whom VEPTR was applied were retrospectively evaluated. AP and lateral Cobb angles that were measured preoperatively and during the last control, SAL, T1-S1, and T1-T12 distances, coronal and sagittal balances were compared.

Conclusions: VEPTR may provide a good correction, and we observed a growth in the spine height and SAL following the treatment of congenital deformities. Long-term, multicenter, prospective studies that compare the spinal height, respiratory functions, the severity of the deformity, and the spinal balance are required in order to evaluate the efficacy of VEPTR.

No MeSH data available.


Related in: MedlinePlus

(a) Preoperative anteroposterior X-ray and clinical appearance. (b) Radiological and clinical results in the postoperative 1st year of rib to pelvis vertical expandable prosthetic titanium rib application. (c) Anteroposterior and LAT radiographies after replacement of rib to pelvis with growing rod and lengthening with vertical expandable prosthetic titanium rib. (d) The rod was removed and replaced with an MCGR together with congenital bar excision. Total follow-up period of this patient was 5.4 years
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Figure 1: (a) Preoperative anteroposterior X-ray and clinical appearance. (b) Radiological and clinical results in the postoperative 1st year of rib to pelvis vertical expandable prosthetic titanium rib application. (c) Anteroposterior and LAT radiographies after replacement of rib to pelvis with growing rod and lengthening with vertical expandable prosthetic titanium rib. (d) The rod was removed and replaced with an MCGR together with congenital bar excision. Total follow-up period of this patient was 5.4 years

Mentions: In the first patient, after 3.4 years following 9 surgical interventions, due to autofusion, VEPTR has lost its effect on the deformity for lengthening and correction, and it was removed. The total follow-up period was 5.8 years, and surgery is planned to correct the remaining deformity. In the second patient, although she was a walking child, we have performed rib-to-rib VEPTR and rib to pelvis iliac hook (Dunn - McCarthy s-hook) due to distal fixation problems. As rib-to-rib expansion was made 2.7 years later, the hook between the rib and pelvis was replaced with a single growing rod. The rod was removed and replaced with a magnetically controlled growing rod (MCGR; MAGEC Ellipse Technology, Irvine, CA.) The total follow-up period of this patient was 5.4 years [Figure 1]. In the third patient, VEPTR was applied due to congenital scoliosis and thorax deformity, and the total follow-up period was 6 years. The device was regularly expanded. VEPTR was removed also in the last patient. This patient was the oldest one in the group. After 2.9 years following the first procedure, maximum spinal growth was obtained, and expansion was effectless anymore. Hence, the device was removed. Selective thoracic posterior instrumentation and fusion were performed. The total follow-up period was 6 years. Opening wedge thoracostomy was repeated in the 2 patients with TIS, due to fibrosis that developed between the ribs during the expansions. The mean time between the expansions was 8.4 months (range: 7.3-9.2). Intraoperative neurophysiological monitoring was used only in the patient having MCGR together with congenital bar excision.


The effect of vertical expandable prosthetic titanium rib on growth in congenital scoliosis.

Balioglu MB, Albayrak A, Akman YE, Atici Y, Kargin D, Kaygusuz MA - J Craniovertebr Junction Spine (2015 Oct-Dec)

(a) Preoperative anteroposterior X-ray and clinical appearance. (b) Radiological and clinical results in the postoperative 1st year of rib to pelvis vertical expandable prosthetic titanium rib application. (c) Anteroposterior and LAT radiographies after replacement of rib to pelvis with growing rod and lengthening with vertical expandable prosthetic titanium rib. (d) The rod was removed and replaced with an MCGR together with congenital bar excision. Total follow-up period of this patient was 5.4 years
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4660498&req=5

Figure 1: (a) Preoperative anteroposterior X-ray and clinical appearance. (b) Radiological and clinical results in the postoperative 1st year of rib to pelvis vertical expandable prosthetic titanium rib application. (c) Anteroposterior and LAT radiographies after replacement of rib to pelvis with growing rod and lengthening with vertical expandable prosthetic titanium rib. (d) The rod was removed and replaced with an MCGR together with congenital bar excision. Total follow-up period of this patient was 5.4 years
Mentions: In the first patient, after 3.4 years following 9 surgical interventions, due to autofusion, VEPTR has lost its effect on the deformity for lengthening and correction, and it was removed. The total follow-up period was 5.8 years, and surgery is planned to correct the remaining deformity. In the second patient, although she was a walking child, we have performed rib-to-rib VEPTR and rib to pelvis iliac hook (Dunn - McCarthy s-hook) due to distal fixation problems. As rib-to-rib expansion was made 2.7 years later, the hook between the rib and pelvis was replaced with a single growing rod. The rod was removed and replaced with a magnetically controlled growing rod (MCGR; MAGEC Ellipse Technology, Irvine, CA.) The total follow-up period of this patient was 5.4 years [Figure 1]. In the third patient, VEPTR was applied due to congenital scoliosis and thorax deformity, and the total follow-up period was 6 years. The device was regularly expanded. VEPTR was removed also in the last patient. This patient was the oldest one in the group. After 2.9 years following the first procedure, maximum spinal growth was obtained, and expansion was effectless anymore. Hence, the device was removed. Selective thoracic posterior instrumentation and fusion were performed. The total follow-up period was 6 years. Opening wedge thoracostomy was repeated in the 2 patients with TIS, due to fibrosis that developed between the ribs during the expansions. The mean time between the expansions was 8.4 months (range: 7.3-9.2). Intraoperative neurophysiological monitoring was used only in the patient having MCGR together with congenital bar excision.

Bottom Line: In our study, we evaluated the effect of VEPTR on growth in congenital scoliosis.Four female patients in whom VEPTR was applied were retrospectively evaluated.VEPTR may provide a good correction, and we observed a growth in the spine height and SAL following the treatment of congenital deformities.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics and Traumatology, Spine Surgery and Arthroplasty Clinic, Metin Sabanci Baltalimani Bone Disease Education and Research Hospital, Istanbul, Turkey.

ABSTRACT

Aims: In the treatment of thoracic insufficiency syndrome, the main aim is to maintain spinal and thoracic growth in order to continue respiratory functions. Vertical expandable prosthetic titanium rib (VEPTR) device application is a method of choice especially in the congenital cases with a thoracic deformity. In our study, we evaluated the effect of VEPTR on growth in congenital scoliosis.

Materials and methods: Four female patients in whom VEPTR was applied were retrospectively evaluated. Anteroposterior (AP) and lateral Cobb angles that were measured preoperatively and during the last control, space available for lung (SAL), T1-S1 and T1-T12 distances, coronal and sagittal balances were compared.

Results: Four female patients in whom VEPTR was applied were retrospectively evaluated. AP and lateral Cobb angles that were measured preoperatively and during the last control, SAL, T1-S1, and T1-T12 distances, coronal and sagittal balances were compared.

Conclusions: VEPTR may provide a good correction, and we observed a growth in the spine height and SAL following the treatment of congenital deformities. Long-term, multicenter, prospective studies that compare the spinal height, respiratory functions, the severity of the deformity, and the spinal balance are required in order to evaluate the efficacy of VEPTR.

No MeSH data available.


Related in: MedlinePlus