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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

Development of thoracic compliance during growth. The vertical expandable prosthetic titanium ribs (VEPTR) group showed a lower thoracic compliance than the control group at the beginning of treatment and at the end of treatment. Increase rate of thoracic compliance during growth did not show any statistically significant differences. Assuming that treatment would begin earlier, the same increase rate of thoracic compliance during growth could lead to a ‘normal’ thoracic compliance at the end of treatment. The arrow head indicates start of treatment (mean age in this study). The dotted line at the left of the arrow head indicates assumed thoracic compliance before treatment. The arrow indicates the theoretical start of treatment as early as possible. The dotted line right to the head of the arrow indicates theoretical thoracic compliance of patients whose treatment started as early as possible. VEPTR, thoracic compliance of VEPTR group; Control, thoracic compliance of healthy control group.
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Figure 3: Development of thoracic compliance during growth. The vertical expandable prosthetic titanium ribs (VEPTR) group showed a lower thoracic compliance than the control group at the beginning of treatment and at the end of treatment. Increase rate of thoracic compliance during growth did not show any statistically significant differences. Assuming that treatment would begin earlier, the same increase rate of thoracic compliance during growth could lead to a ‘normal’ thoracic compliance at the end of treatment. The arrow head indicates start of treatment (mean age in this study). The dotted line at the left of the arrow head indicates assumed thoracic compliance before treatment. The arrow indicates the theoretical start of treatment as early as possible. The dotted line right to the head of the arrow indicates theoretical thoracic compliance of patients whose treatment started as early as possible. VEPTR, thoracic compliance of VEPTR group; Control, thoracic compliance of healthy control group.

Mentions: The result is illustrated in Figure 3: pre-operative (Pre) and post-operative (POP) compliance of the VEPTR group is lower than that of normal controls, but the slope of improvement matched that of normal controls.


Vertical expandable prosthetic titanium ribs (VEPTR) in early-onset scoliosis: impact on thoracic compliance and sagittal balance
Development of thoracic compliance during growth. The vertical expandable prosthetic titanium ribs (VEPTR) group showed a lower thoracic compliance than the control group at the beginning of treatment and at the end of treatment. Increase rate of thoracic compliance during growth did not show any statistically significant differences. Assuming that treatment would begin earlier, the same increase rate of thoracic compliance during growth could lead to a ‘normal’ thoracic compliance at the end of treatment. The arrow head indicates start of treatment (mean age in this study). The dotted line at the left of the arrow head indicates assumed thoracic compliance before treatment. The arrow indicates the theoretical start of treatment as early as possible. The dotted line right to the head of the arrow indicates theoretical thoracic compliance of patients whose treatment started as early as possible. VEPTR, thoracic compliance of VEPTR group; Control, thoracic compliance of healthy control group.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Development of thoracic compliance during growth. The vertical expandable prosthetic titanium ribs (VEPTR) group showed a lower thoracic compliance than the control group at the beginning of treatment and at the end of treatment. Increase rate of thoracic compliance during growth did not show any statistically significant differences. Assuming that treatment would begin earlier, the same increase rate of thoracic compliance during growth could lead to a ‘normal’ thoracic compliance at the end of treatment. The arrow head indicates start of treatment (mean age in this study). The dotted line at the left of the arrow head indicates assumed thoracic compliance before treatment. The arrow indicates the theoretical start of treatment as early as possible. The dotted line right to the head of the arrow indicates theoretical thoracic compliance of patients whose treatment started as early as possible. VEPTR, thoracic compliance of VEPTR group; Control, thoracic compliance of healthy control group.
Mentions: The result is illustrated in Figure 3: pre-operative (Pre) and post-operative (POP) compliance of the VEPTR group is lower than that of normal controls, but the slope of improvement matched that of normal controls.

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