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Vertical expandable prosthetic titanium ribs (VEPTR) in early-onset scoliosis: impact on thoracic compliance and sagittal balance

View Article: PubMed Central - PubMed

ABSTRACT

Background: Theoretically, dynamic thoracic compliance (DTC) should be reduced by vertical expandable prosthetic titanium ribs (VEPTR) since titanium rods, scar tissue and ossifications increase stiffness of the rib cage. The effect of VEPTR on thoracic compliance has not yet been elucidated. The impact of VEPTR on the development of sagittal balance has not been fully investigated.

Patients and methods: In a retrospective study, we investigated 21 consecutive children who were treated by VEPTR from 2004 to 2011 and three control groups. We compared the development of thoracic compliance during growth to Nr1. Development of sagittal balance during growth was compared to Nr2 and to Nr3 (which has been instrumented from ileum to rib). Mean follow-up was 60.67 months (standard error of the mean (SE 4.77).

Results: The difference of change of DTC during growth of VEPTR group versus a control group was not significant (p < 0.05). However, initial DTC and DTC at last follow-up of VEPTR group were lower than DTC of the control group. The difference was significant (p < 0.05). Mean correction of Cobb angle after the first operation was 16.41° (SE 3.01). Until last follow-up, we saw a loss of correction of 8.23° (SE 3.22). The differences between the development of parameters of sagittal balance during growth between the VEPTR group, control group 2 and control group 3 were not significant (p > 0.05).

Conclusions: VEPTR treatment should start as early as possible since VEPTR seems to lead to an increased rate of DTC that is similar to healthy controls. Sagittal balance showed a similar development as in healthy children.

No MeSH data available.


Related in: MedlinePlus

A female child with congenital scoliosis combined with rib synostosis. Treatment with vertical expandable prosthetic titanium ribs (VEPTR) was started at the age of 2.5 years. The child was not enrolled in the study. (A) Pre-operative CT scan, 3D reconstruction. Arrow points at rib synostosis. (B) Pre-operative CT scan, coronal plane reconstruction. Arrow points at hemivertebra. (C) Post-operative posteroanterior (PA) radiograph of the spine. At the age of 2.5 years, VEPTR was implanted with osteotomy of rib synostosis. (D) PA radiograph of the spine at the age of 11 years after multiple elongation procedures. Frontal balance acceptable. (E) Sagittal radiograph of the spine at the age of 11 years. Sagittal balance acceptable.
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Figure 1: A female child with congenital scoliosis combined with rib synostosis. Treatment with vertical expandable prosthetic titanium ribs (VEPTR) was started at the age of 2.5 years. The child was not enrolled in the study. (A) Pre-operative CT scan, 3D reconstruction. Arrow points at rib synostosis. (B) Pre-operative CT scan, coronal plane reconstruction. Arrow points at hemivertebra. (C) Post-operative posteroanterior (PA) radiograph of the spine. At the age of 2.5 years, VEPTR was implanted with osteotomy of rib synostosis. (D) PA radiograph of the spine at the age of 11 years after multiple elongation procedures. Frontal balance acceptable. (E) Sagittal radiograph of the spine at the age of 11 years. Sagittal balance acceptable.

Mentions: VEPTR was primarily applied with thoracostomy in patients with thoracic malformation that induced scoliosis.3,4 With VEPTR instrumentation osteotomies of rib synostosis were performed and thoracic compliance theoretically improved because the bony elements of the thorax became less rigid. Implantation of stiffening VEPTR may dilute or even counter that effect. It is reported that thoracic volume was increased acutely (Fig. 1).4 The effect on thoracic compliance is not reported.


Vertical expandable prosthetic titanium ribs (VEPTR) in early-onset scoliosis: impact on thoracic compliance and sagittal balance
A female child with congenital scoliosis combined with rib synostosis. Treatment with vertical expandable prosthetic titanium ribs (VEPTR) was started at the age of 2.5 years. The child was not enrolled in the study. (A) Pre-operative CT scan, 3D reconstruction. Arrow points at rib synostosis. (B) Pre-operative CT scan, coronal plane reconstruction. Arrow points at hemivertebra. (C) Post-operative posteroanterior (PA) radiograph of the spine. At the age of 2.5 years, VEPTR was implanted with osteotomy of rib synostosis. (D) PA radiograph of the spine at the age of 11 years after multiple elongation procedures. Frontal balance acceptable. (E) Sagittal radiograph of the spine at the age of 11 years. Sagittal balance acceptable.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5382335&req=5

Figure 1: A female child with congenital scoliosis combined with rib synostosis. Treatment with vertical expandable prosthetic titanium ribs (VEPTR) was started at the age of 2.5 years. The child was not enrolled in the study. (A) Pre-operative CT scan, 3D reconstruction. Arrow points at rib synostosis. (B) Pre-operative CT scan, coronal plane reconstruction. Arrow points at hemivertebra. (C) Post-operative posteroanterior (PA) radiograph of the spine. At the age of 2.5 years, VEPTR was implanted with osteotomy of rib synostosis. (D) PA radiograph of the spine at the age of 11 years after multiple elongation procedures. Frontal balance acceptable. (E) Sagittal radiograph of the spine at the age of 11 years. Sagittal balance acceptable.
Mentions: VEPTR was primarily applied with thoracostomy in patients with thoracic malformation that induced scoliosis.3,4 With VEPTR instrumentation osteotomies of rib synostosis were performed and thoracic compliance theoretically improved because the bony elements of the thorax became less rigid. Implantation of stiffening VEPTR may dilute or even counter that effect. It is reported that thoracic volume was increased acutely (Fig. 1).4 The effect on thoracic compliance is not reported.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Theoretically, dynamic thoracic compliance (DTC) should be reduced by vertical expandable prosthetic titanium ribs (VEPTR) since titanium rods, scar tissue and ossifications increase stiffness of the rib cage. The effect of VEPTR on thoracic compliance has not yet been elucidated. The impact of VEPTR on the development of sagittal balance has not been fully investigated.

Patients and methods: In a retrospective study, we investigated 21 consecutive children who were treated by VEPTR from 2004 to 2011 and three control groups. We compared the development of thoracic compliance during growth to Nr1. Development of sagittal balance during growth was compared to Nr2 and to Nr3 (which has been instrumented from ileum to rib). Mean follow-up was 60.67 months (standard error of the mean (SE 4.77).

Results: The difference of change of DTC during growth of VEPTR group versus a control group was not significant (p < 0.05). However, initial DTC and DTC at last follow-up of VEPTR group were lower than DTC of the control group. The difference was significant (p < 0.05). Mean correction of Cobb angle after the first operation was 16.41° (SE 3.01). Until last follow-up, we saw a loss of correction of 8.23° (SE 3.22). The differences between the development of parameters of sagittal balance during growth between the VEPTR group, control group 2 and control group 3 were not significant (p > 0.05).

Conclusions: VEPTR treatment should start as early as possible since VEPTR seems to lead to an increased rate of DTC that is similar to healthy controls. Sagittal balance showed a similar development as in healthy children.

No MeSH data available.


Related in: MedlinePlus