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

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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.


A male child with idiopathic EOS. Treatment with vertical expandable prosthetic titanium ribs (VEPTR) was started at the age of 3.5 years. (A) MRI of whole spine, coronal plane reconstruction. (B) Post-operative whole spine posteroanterior (PA) radiograph at the age of 3.5 years. Frontal balance acceptable. (C) Post-operative whole spine sagittal radiograph at the age of 3.5 years. Sagittal balance acceptable. (D) Whole spine PA radiograph at the age of ten years. No change in frontal balance. (E) Whole spine sagittal radiograph at the age of 3.5 years. No change in sagittal balance.
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Figure 2: A male child with idiopathic EOS. Treatment with vertical expandable prosthetic titanium ribs (VEPTR) was started at the age of 3.5 years. (A) MRI of whole spine, coronal plane reconstruction. (B) Post-operative whole spine posteroanterior (PA) radiograph at the age of 3.5 years. Frontal balance acceptable. (C) Post-operative whole spine sagittal radiograph at the age of 3.5 years. Sagittal balance acceptable. (D) Whole spine PA radiograph at the age of ten years. No change in frontal balance. (E) Whole spine sagittal radiograph at the age of 3.5 years. No change in sagittal balance.

Mentions: Since the growing rod technique9 (instrumentation spine to spine, ileum to spine) may cause spontaneous spinal fusion. Also, the use of VEPTR in patients without thoracic induced scoliosis10 by instrumentation from rib to rib, ileum to rib or spine to rib (Fig. 2) was established because it was thought to avoid spinal fusion. Recent reports contradict this theory by stating that VEPTR regularly causes spontaneous spinal fusion.8


Vertical expandable prosthetic titanium ribs (VEPTR) in early-onset scoliosis: impact on thoracic compliance and sagittal balance
A male child with idiopathic EOS. Treatment with vertical expandable prosthetic titanium ribs (VEPTR) was started at the age of 3.5 years. (A) MRI of whole spine, coronal plane reconstruction. (B) Post-operative whole spine posteroanterior (PA) radiograph at the age of 3.5 years. Frontal balance acceptable. (C) Post-operative whole spine sagittal radiograph at the age of 3.5 years. Sagittal balance acceptable. (D) Whole spine PA radiograph at the age of ten years. No change in frontal balance. (E) Whole spine sagittal radiograph at the age of 3.5 years. No change in sagittal balance.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: A male child with idiopathic EOS. Treatment with vertical expandable prosthetic titanium ribs (VEPTR) was started at the age of 3.5 years. (A) MRI of whole spine, coronal plane reconstruction. (B) Post-operative whole spine posteroanterior (PA) radiograph at the age of 3.5 years. Frontal balance acceptable. (C) Post-operative whole spine sagittal radiograph at the age of 3.5 years. Sagittal balance acceptable. (D) Whole spine PA radiograph at the age of ten years. No change in frontal balance. (E) Whole spine sagittal radiograph at the age of 3.5 years. No change in sagittal balance.
Mentions: Since the growing rod technique9 (instrumentation spine to spine, ileum to spine) may cause spontaneous spinal fusion. Also, the use of VEPTR in patients without thoracic induced scoliosis10 by instrumentation from rib to rib, ileum to rib or spine to rib (Fig. 2) was established because it was thought to avoid spinal fusion. Recent reports contradict this theory by stating that VEPTR regularly causes spontaneous spinal fusion.8

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.