[Operative treatment of scolioses with the VEPTR instrumentation].

OBJECTIVE

In 1993, A. Campel published the VEPTR (vertical expandable prosthetic titanium rib) instrumentation for the treatment of thoracic insufficiency syndrome (TIS). The goal of surgery is to lengthen and expand the constricted concave hemithorax to the height of the convex sides to increase thoracic volume, to obtain thoracic symmetry, to improve thoracic function, to maintain these improvement during growth of the child, and to avoid growth inhibition procedures, if possible.

INDICATIONS

TIS. Congenital scoliosis. Early-onset scoliosis (EOS). Neurogenic scoliosis.

CONTRAINDICATIONS

Hyperkyphosis > 70 degrees according to Cobb. Osteoporotic bone. Children > 10 years.

SURGICAL TECHNIQUE

Through a standard thoracotomy incision, an openingwedge thoracocostotomy is performed by cutting a transverse osteotomy from transverse process to sternum through the fused ribs at the apex of the thoracic deformity. The interval is distracted by lamina spreaders. A vertical expandable prosthetic titanium rib (VEPTR) is inserted to hold the acute operative correction. Curves going into the lumbar spine are treated with a hybrid device. In follow-up surgeries at intervals of 4-6 months the devices are expanded through a limited incision at their base to maintain correction with growth.

POSTOPERATIVE MANAGEMENT

Postoperative Management Patients can be mobilized after the 3rd day of surgery without a brace.

RESULTS

From 2005 to 2009, 39 patients (24 female, 15 male, mean age at surgery 7.5 years [3-13 years]) were treated with VEPTR. The diagnosis was congenital scoliosis in 16, neurogenic scoliosis in eleven, and EOS in twelve cases. Seven of the 39 patients had undergone previous surgery. The curve was measured according to Cobb. The mean Cobb angle was 65 degrees (45-130 degrees ) preoperatively and 32 degrees (25-75 degrees ) postoperatively. During the first surgery, no complications occurred. Mean operating time was 95 min (65-185 min). Mean blood loss amounted to 125 ml (65-180 ml). 29 of the 39 patients had one to nine lengthening procedures. The mean correction achieved was 15.7 degrees (19.8%). In three cases, the VEPTR instrumentation was removed and a final fusion performed. All parents and patients were satisfied with the operation and would undergo it again.