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European Spine Journal

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01-07-2014 | Ideas and Technical Innovations

Treatment of congenital thoracic scoliosis with associated rib fusions using VEPTR expansion thoracostomy: a surgical technique

Authors: Romain Dayer, Dimitri Ceroni, Pierre Lascombes

Published in: European Spine Journal | Special Issue 4/2014

Abstract

Introduction

Untreated growing patients with congenital scoliosis and fused ribs will develop finally thoracic insufficiency syndrome. The technique of expansion thoracoplasty with implantation of a vertical expandable prosthetic titanium rib (VEPTR) was introduced initially to treat these children.

Methods

This article attempts to provide an overview of the surgical technique of opening-wedge thoracostomy and VEPTR instrumentation in children with congenital thoracic scoliosis and fused ribs.

Results

Our modification of the surgical approach using a posterior midline incision rather than the modified thoracotomy incision initially described could potentially help to diminish wound dehiscence and secondary infection, while preserving a more acceptable esthetic appearance of the back.

Conclusions

Vertical expandable prosthetic titanium rib-based treatments should be undertaken only with a good knowledge of its numerous specific complications. Every aspect of the treatment should be oriented to minimize these complications. At the same time it should be kept in mind that the ultimate step of this long-term fusionless treatment strategy will be a technically demanding spine fusion.

Campbell RM Jr, Smith MD, Mayes TC et al (2004) The effect of opening wedge thoracostomy on thoracic insufficiency syndrome associated with fused ribs and congenital scoliosis. J Bone Joint Surg Am 86-A:1659–1674PubMed

Campbell RM Jr, Smith MD, Hell-Vocke AK (2004) Expansion thoracoplasty: the surgical technique of opening-wedge thoracostomy. Surgical technique. J Bone Joint Surg Am 86-A(Suppl 1):51–64PubMed

Flynn JM, Ramirez N, Emans JB et al (2011) Is the vertebral expandable prosthetic titanium rib a surgical alternative in patients with spina bifida? Clin Orthop Relat Res 469:1291–1296PubMedCentralPubMedCrossRef

Hasler CC, Mehrkens A, Hefti F (2010) Efficacy and safety of VEPTR instrumentation for progressive spine deformities in young children without rib fusions. Eur Spine J 19:400–408PubMedCentralPubMedCrossRef

Hell AK, Campbell RM, Hefti F (2005) The vertical expandable prosthetic titanium rib implant for the treatment of thoracic insufficiency syndrome associated with congenital and neuromuscular scoliosis in young children. J Pediatr Orthop B 14:287–293PubMedCrossRef

Campbell RM Jr, Hell-Vocke AK (2003) Growth of the thoracic spine in congenital scoliosis after expansion thoracoplasty. J Bone Joint Surg Am 85-A:409–420PubMed

Campbell RM Jr, Smith MD, Mayes TC et al (2003) The characteristics of thoracic insufficiency syndrome associated with fused ribs and congenital scoliosis. J Bone Joint Surg Am 85-A:399–408PubMed

Lewandrowski KU, Cambell RM, Emans JB (2001) Vertical rib expansion for thoracic insufficiency syndrome indications and technique. Orthop J Harv Med Sch 3:65–73

Campbell RM Jr, Adcox BM, Smith MD et al (2007) The effect of mid-thoracic VEPTR opening wedge thoracostomy on cervical tilt associated with congenital thoracic scoliosis in patients with thoracic insufficiency syndrome. Spine 32:2171–2177PubMedCrossRef

10.

Emans JB, Caubet JF, Ordonez CL et al (2005) The treatment of spine and chest wall deformities with fused ribs by expansion thoracostomy and insertion of vertical expandable prosthetic titanium rib: growth of thoracic spine and improvement of lung volumes. Spine 30:S58–S68PubMedCrossRef

11.

Gadepalli SK, Hirschl RB, Tsai WC et al (2011) Vertical expandable prosthetic titanium rib device insertion: does it improve pulmonary function? J Pediatr Surg 46:77–80PubMedCrossRef

12.

Hell AK, Hefti F, Campbell RM (2004) Behandlung der kongenitalen skoliose mit dem vertical-expandable-prosthetic-titanium-rib-Implant. Orthopaedics 33:911–918

13.

Samy MA, Al Zayed ZS, Shaheen MF (2009) The effect of a vertical expandable prosthetic titanium rib on shoulder balance in patients with congenital scoliosis. J Child Orthop 3:391–396PubMedCentralPubMedCrossRef

14.

Waldhausen JH, Redding GJ, Song KM (2007) Vertical expandable prosthetic titanium rib for thoracic insufficiency syndrome: a new method to treat an old problem. J Pediatr Surg 42:76–80PubMedCrossRef

15.

Gill R, Kinsella CR Jr, Lin AY et al (2011) Acellular dermal matrix in the treatment and prevention of exposed vertical expandable prosthetic titanium ribs. Spine 36:E563–E567PubMedCrossRef

16.

Lacher M, Dietz HG (2011) VEPTR (Vertical Expandible Prosthetic Titanium Rib) treatment for Jeune syndrome. Eur J Pediatr Surg 21:138–139PubMedCrossRef

17.

Ramirez N, Flynn JM, Emans JB et al (2010) Vertical expandable prosthetic titanium rib as treatment of thoracic insufficiency syndrome in spondylocostal dysplasia. J Pediatr Orthop 30:521–526PubMedCrossRef

18.

Reinker K, Simmons JW, Patil V et al (2011) Can VEPTR^(R) control progression of early-onset kyphoscoliosis? A cohort study of VEPTR^(R) patients with severe kyphoscoliosis. Clin Orthop Relat Res 469:1342–1348PubMedCentralPubMedCrossRef

19.

Smith MD, Campbell RM (2006) Use of a biodegradable patch for reconstruction of large thoracic cage defects in growing children. J Pediatr Surg 41:46–49PubMedCrossRef

20.

Akbarnia BA, Emans JB (2010) Complications of growth-sparing surgery in early onset scoliosis. Spine 35:2193–2204PubMedCrossRef

21.

Greggi T, Lolli F, Di Silvestre M et al (2012) Complications incidence in the treatment of early onset scoliosis with growing spinal implants. Stud Health Technol Inform 176:334–337PubMed

22.

Latalski M, Fatyga M, Gregosiewicz A (2011) Problems and complications in VEPTR-based treatment. Ortop Traumatol Rehabil 13:449–455PubMedCrossRef

23.

Yazici M, Emans J (2009) Fusionless instrumentation systems for congenital scoliosis: expandable spinal rods and vertical expandable prosthetic titanium rib in the management of congenital spine deformities in the growing child. Spine 34:1800–1807PubMedCrossRef

24.

Sankar WN, Acevedo DC, Skaggs DL (2010) Comparison of complications among growing spinal implants. Spine 35:2091–2096PubMed

25.

Testut L (1896) Traité d’anatomie humaine, 3rd edn. Octave Doin, Paris

26.

Beals RK, Robbins JR, Rolfe B (1993) Anomalies associated with vertebral malformations. Spine 18:1329–1332PubMedCrossRef

27.

Hedequist D, Emans J (2004) Congenital scoliosis. J Am Acad Orthop Surg 12:266–275PubMed

28.

Drvaric DM, Ruderman RJ, Conrad RW et al (1987) Congenital scoliosis and urinary tract abnormalities: are intravenous pyelograms necessary? J Pediatr Orthop 7:441–443PubMedCrossRef

29.

MacEwen GD, Winter RB, Hardy JH (1972) Evaluation of kidney anomalies in congenital scoliosis. J Bone Joint Surg Am 54:1451–1454PubMed

30.

Basu PS, Elsebaie H, Noordeen MH (2002) Congenital spinal deformity: a comprehensive assessment at presentation. Spine 27:2255–2259PubMedCrossRef

31.

McMaster MJ (1984) Occult intraspinal anomalies and congenital scoliosis. J Bone Joint Surg Am 66:588–601PubMed

32.

Suh SW, Sarwark JF, Vora A et al (2001) Evaluating congenital spine deformities for intraspinal anomalies with magnetic resonance imaging. J Pediatr Orthop 21:525–531PubMed

33.

England SJ (1988) Current techniques for assessing pulmonary function in the newborn and infant: advantages and limitations. Pediatr Pulmonol 4:48–53PubMedCrossRef

34.

Lattig F, Taurman R, Hell AK (2012) Treatment of Early Onset Spinal Deformity (EOSD) with VEPTR: a challenge for the final correction spondylodesis: a case series. J Spinal Disord Tech [Epub ahead of print]

35.

Mayer OH, Redding G (2009) Early changes in pulmonary function after vertical expandable prosthetic titanium rib insertion in children with thoracic insufficiency syndrome. J Pediatr Orthop 29:35–38PubMedCrossRef

36.

Motoyama EK, Yang CI, Deeney VF (2009) Thoracic malformation with early-onset scoliosis: effect of serial VEPTR expansion thoracoplasty on lung growth and function in children. Paediatr Respir Rev 10:12–17PubMedCrossRef

37.

Smith JT (2011) Bilateral rib-to-pelvis technique for managing early-onset scoliosis. Clin Orthop Relat Res 469:1349–1355PubMedCentralPubMedCrossRef

38.

Sponseller PD, Yang JS, Thompson GH et al (2009) Pelvic fixation of growing rods: comparison of constructs. Spine 4(16):1706–1710CrossRef

Title: Treatment of congenital thoracic scoliosis with associated rib fusions using VEPTR expansion thoracostomy: a surgical technique
Authors: Romain Dayer
Dimitri Ceroni
Pierre Lascombes
Publication date: 01-07-2014
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue Special Issue 4/2014
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-014-3338-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Treatment of congenital thoracic scoliosis with associated rib fusions using VEPTR expansion thoracostomy: a surgical technique

Abstract

Introduction

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

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