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Clinical Orthopaedics and Related Research®
Published in: Clinical Orthopaedics and Related Research® 5/2011

01-05-2011 | Symposium: Myelomeningocele

Is the Vertebral Expandable Prosthetic Titanium Rib a Surgical Alternative in Patients with Spina Bifida?

Published in: Clinical Orthopaedics and Related Research® | Issue 5/2011

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Abstract

Background

Nonambulatory children with myelodysplasia are most likely to develop spinal deformity. As the deformity progresses, the overall health of the patient deteriorates. Traditional management of the deformity with fusion results in a short trunk, crankshaft deformity, and spine and lung growth inhibition. One alternative that potentially minimizes these problems is the vertebral expandable prosthetic titanium rib (VEPTR).

Questions/purposes

We therefore asked whether the use of the VEPTR in immature nonambulating children with myelodysplasia with spinal deformity would (1) correct deformity; (2) allow growth; and (3) allow adequate respiratory function.

Patients and Methods

We identified 20 nonambulatory patients with myelodysplasia who were part of a multicenter Investigational Device Exemption study of 214 patients treated with the VEPTR system. Demographics, standard radiographic measurements, pulmonary function parameters, and complications in 16 patients were analyzed. Average age at first surgery was 48.6 months. The minimum followup was 25 months (mean, 59 months; range, 25–164 months).

Results

The Cobb angle decreased postoperatively in nine patients, increased less than 10° in five patients, and increased less than 20° in two patients. The mean increase in thoracic spinal length (growth) by year after the initial procedure with lengthening was 0.48 cm. Ventilatory function improved in 11 patients and deteriorated in five patients. Intraoperative complications occurred in two patients. Complications directly related to the implant were seven infections and five implant migrations.

Conclusions

Our observations suggest VEPTR is a reasonable treatment option for spinal deformity in the immature, nonambulatory myelodysplasia population correcting the spinal deformity, allowing spinal growth, and maintaining adequate respiratory function. The rate of complications is within the range reported for spinal fusion using standard approaches.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Literature
1.
Banta JV. Combined anterior and posterior fusion for spinal deformity in myelomeningocele. Spine. 1990;15:946–952.PubMedCrossRef
2.
Campbell R, Smith M, Mayes T, Mangos JA, Willey-Courand DB, Kose N, Pinero RF, Alder ME, Duong HL, Surber JL. The effect of opening wedge thoracostomy on thoracic insufficiency syndrome associated with fused ribs and congenital scoliosis. J Bone Joint Surg Am. 2004;86:1659–1674.PubMed
3.
Campbell RM, Hell-Vocke AK. Growth of the thoracic spine in congenital scoliosis after expansion thoracoplasty. J Bone Joint Surg Am. 2003;85:409–420.PubMed
4.
Campbell RM, Smith M. Thoracic insufficiency syndrome and exotics scoliosis. J Bone Joint Surg Am. 2007;89:108–122.PubMedCrossRef
5.
Campbell RM, Smith MD, Mayes TC, Mangos JA, Willey-Courand DB, Kose N, Pinero RF, Alder ME, Duong HL, Surber JL. The characteristics of thoracic insufficiency syndrome associated with fused rib and congenital scoliosis. J Bone Joint Surg Am. 2003;85:399–408.PubMedCrossRef
6.
Carstens C, Paul K, Niethard F, Pfiel J. Effect of scoliosis surgery on pulmonary function in patients with myelomeningocele. J Pediatr Orthop. 1991;11:459–464.PubMedCrossRef
7.
Cobb JR. Outline for the study of scoliosis. In: Edwards JW, ed. Instructional Course Lectures. Vol 5. Ann Arbor: American Academy of Orthopaedic Surgeons; 1948:261–275.
8.
DiMeglio A, Bonnel F. The Growing Spine. Paris, France: Springer; 1990.
9.
Emans J, Caubet J, Ordonez C, Lee EY, Ciarlo M. 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 (Phila Pa 1976). 2005;30(Suppl):S58–68.
10.
Guille JT, Sarwark JF, Sherk H, Kumar SJ. Congenital and developmental deformities of the spine in children with myelomeningocele. J Am Acad Orthop Surg. 2006;14:294–302.PubMed
11.
Marchesi D, Rudeberg A, Aebi M. Development in conservatively treated scoliosis in patients with myelomeningocele (patients of the years 1964–1977). Acta Orthop Belg. 1991;57:390–398.PubMed
12.
McMaster MJ. Anterior and posterior instrumentation and fusion of thoracolumbar scoliosis due to myelomeningocele. J Bone Joint Surg Br. 1987;69:20–25.PubMed
13.
Muller EB, Nordwall A, Oden A. Progression of scoliosis in children with myelomeningocele. Spine. 1994;19:147–150.PubMedCrossRef
14.
Sherman MS, Kaplan JM, Effgen S, Campbell D, Dold F. Pulmonary dysfunction and reduced exercise capacity in patients with myelomeningocoele. J Pediatr. 1997;131:413–418.PubMedCrossRef
15.
Ward WT, Wenger DR, Roach JW. Surgical correction of myelomeningocele scoliosis: a critical appraisal of various spinal instrumentation systems. J Pediatr Orthop. 1989;9:262–268.PubMed
Metadata
Title
Is the Vertebral Expandable Prosthetic Titanium Rib a Surgical Alternative in Patients with Spina Bifida?
Publication date
01-05-2011
Published in
Clinical Orthopaedics and Related Research® / Issue 5/2011
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-010-1620-1

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