Background: In 2007, this prospective study on vertical expandable prosthetic titanium rib (VEPTR) treatment of early onset scoliosis in children without rib abnormalities was initiated. Two-year follow-up results have previously been reported. This study examines whether, at 5-year follow-up, VEPTR continues to control scoliosis and allow spinal growth.
Methods: A prospective, multicenter, observational cohort design was used. Patients underwent traditional VEPTR implantation ≥5 years before analysis. Preimplantation and last available images were compared, regardless of whether VEPTR remained in vivo. Additional analysis was performed if VEPTR was in vivo ≥5 years.
Results: This study included 59 patients (mean age at VEPTR implantation, 6.1±2.4 y; mean follow-up, 6.9±1.4 y). Currently, 24 patients still have VEPTR, whereas 24 have converted (13 fusions, 6 MCGR, 3 growing rods, 1 hybrid, and 1 Shilla). Three have had VEPTR explanted, 6 are unknown, and 2 have deceased. On last available imaging (n=59; mean follow-up, 4.8±1.9 y), scoliosis improved from 71.8±18.0 degrees preoperatively to 60.9±20.3 degrees (P<0.001) and T1- T12 height increased (15.8±3.2 to 19.3±3.8 cm, P<0.001). T1-S1 height also increased (24.8±4.4 to 31.2±5.3 cm, P<0.001), representing 119% age-matched growth. Composite improvement of scoliosis, T1-T12, and T1-S1 height was achieved in 79% of patients. A subset of 29 patients with VEPTR was analyzed at most recent follow-up ≥5 years while VEPTR remained in vivo (24 patients with VEPTR above, and 5 who later converted to other devices). Mean age at implantation was 5.0±2.2 years, with a mean VEPTR treatment duration of 6.2±1.1 years. Scoliosis improved from preoperatively (69.3±14.5 to 61.6±16.1 degrees, P=0.006), with mild recurrence from postoperative to 5 years. T1-T12 height increased (15.0±3.3 to 18.7±3.3 cm, P<0.001) and T1-S1 height increased (23.7±4.5 to 30.1±4.6 cm, P<0.001), representing 83% age-matched growth. Composite improvement was achieved in 83% of patients. Instrumented sagittal length also increased during this period (21.8±4.2 to 30.3±5.1 cm, P<0.001).
Conclusion: At a 5-year follow-up, VEPTR continues to control scoliosis and allow spinal growth.
Level of evidence: Level II-prospective cohort, therapeutic study.
VEPTR Implantation to Treat Children With Early-Onset Scoliosis Without Rib Abnormalities: Early Results From a Prospective Multicenter StudyR El-Hawary et al. J Pediatr Orthop 37 (8), e599-e605. PMID 28141685.At 2-year follow-up, VEPTR was effective in treating EOS without rib abnormalities with 86% of patients having an improvement in scoliosis and 94% of patients having an i …
A Comparison of Growth Among Growth-Friendly Systems for Scoliosis: A Systematic ReviewSPJ Wijdicks et al. Spine J 19 (5), 789-799. PMID 30290228. - ReviewReporting on spinal growth is currently inadequate and does not allow a good comparison of different techniques. However, all systems often report growth similar to Dimeg …
Use of Vertical Expandable Prosthetic Titanium Rib (VEPTR) in the Treatment of Congenital Scoliosis Without Fused RibsRF Murphy et al. J Pediatr Orthop 36 (4), 329-35. PMID 25887832.VEPTR is an effective treatment for patients with CS without fused ribs, as evidenced by improved radiographic parameters and increased spinal height, with a complication …
Spinal Deformity Changes in Children With Long-Term Vertical Expandable Prosthetic Titanium Rib TreatmentAS Gantner et al. Spine J 18 (4), 567-574. PMID 28842365.In children with spinal deformity, implantation of the VEPTR device sufficiently corrected the deformity in all planes. During long-term follow-up, scoliosis increased sl …
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 ChildM Yazici et al. Spine (Phila Pa 1976) 34 (17), 1800-7. PMID 19644331. - ReviewGrowing rod technique should be used in patients where the primary problem is at the vertebral column. If the patient has rib fusions and/or TIS has developed, in other w …