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. 2011 May;469(5):1335-41.
doi: 10.1007/s11999-010-1749-y.

VEPTR™ Growing Rods for Early-Onset Neuromuscular Scoliosis: Feasible and Effective

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Free PMC article

VEPTR™ Growing Rods for Early-Onset Neuromuscular Scoliosis: Feasible and Effective

Klane K White et al. Clin Orthop Relat Res. .
Free PMC article

Abstract

Background: The Vertical Expandable Prosthetic Titanium Rib (VEPTR™; Synthes North America, West Chester, PA) reportedly controls spinal deformity associated with constrictive chest wall conditions.

Questions/purposes: We asked whether spine-to-spine constructs using VEPTR™ instrumentation in combination with standard spinal instrumentation could be deployed to salvage failed rib-to-spine constructs used originally in patients with constricted chest walls and to primarily treat progressive spinal deformity without chest wall abnormalities.

Patients and methods: Fifty patients were treated with VEPTR™ constructs for thoracic insufficiency syndrome at our center between 2001 and 2007. Fourteen of these 50 patients had placement of a spine-to-spine construct using a VEPTR™ implant in combination with standard spinal implants and are the subject of this retrospective review. Five had prior rib-based VEPTR™ or growing implants with an average of two failures before this surgery. Radiographic variables, preceding treatment, complications, and changes in ambulatory status, were recorded. The minimum followup was 2 years (mean, 35 months; range, 2-4 years).

Results: After an average of five expansions in these 14 patients, positive changes were recorded for Cobb angle, T1-S1 height, sagittal balance, and space available for the lung. Complications included two rod fractures, two superficial infections, and one deep infection with rod removal.

Conclusions: VEPTR™ instrumentation as a spine-to-spine growing-rod construct demonstrated ease of implantation and expansion, with complication rates similar to other reported devices. This study suggests growing constructs using VEPTR™ can be used with relatively few complications and extends the potential uses of this instrumentation system.

Figures

Fig. 1A–E
Fig. 1A–E
Radiographs illustrate the case of a female patient with neuromuscular scoliosis (Patient 14). (A) A pretreatment radiograph shows the initial deformity. (B) The first rib-based construct resulted in a progression of the deformity 1 year after implant. (C) The first construct was converted to a rib-to-pelvis construct. (D) The left rod was removed after three proximal rib fractures, distal anchor migration, and revisions. (E) The construct was converted to a VEPTR™ spine-based construct using conventional spine implants for anchors.
Fig. 2
Fig. 2
Limited exposure is required at the upper and lower ends of the spinal construct. Implants are passed subfascially through a space created by a shunt passer and chest tube.
Fig. 3
Fig. 3
Two patients had fracture of the implant that occurred as a result of contouring of the hybrid rod near the rod sleeve attachment.

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