Lattig Friederike, Taurman Rita, Hell Anna K
*Department Orthopädie, Universitäts-und Rehabilitationsklinik, Ulm†Universitätsmedizin Göttingen, Göttingen, Germany.
Clin Spine Surg. 2016 Jun;29(5):E246-51. doi: 10.1097/BSD.0b013e31826eaf27.
Case Series.
To describe the post-VEPTR (vertical expandable prosthetic titanium rib) treatment changes in early-onset spinal deformity (EOSD), which may influence the final correction spondylodesis.
The VEPTR device, originally developed for the treatment of congenital rib cage malformation, is nowadays more widely used in the treatment of EOSD. At present, only a few reports describe the possible complications that may occur with repeated lengthening procedures of the VEPTR, thereby making the final spondylodesis more complicated and less satisfactory.
X-rays of 5 children treated for EOSD with 2 unilateral VEPTR (each rib to rib and rib to lumbar lamina) were analyzed for curve patterns and Cobb angles before, during, and at the end of VEPTR treatment, and after the final spondylodesis. Intraoperative observations during the spondylodesis, which influenced the possibilities of the curve correction, were documented.
All patients showed a marked decompensation of the frontal balance and a high degree of rigidity of the main curve and the compensatory curves after treatment with the VEPTR device. Because of this spontaneous autofusion of spinal segments, migration of the rib cradles and/or the laminar hook, and a change in the curve patterns, the final fusion had to be longer in all patients than the primary deformity would have intended.
If an EOSD is treated with VEPTR, the curve progression and, in particular, the development of a high thoracic hyperkyphosis or rotation of the main curve should be critically observed. Autofusion of ribs and vertebral bodies may make the final correction spondylodesis even more challenging and risky for the patient and the end result less satisfactory.
病例系列研究。
描述早期脊柱畸形（EOSD）患者在接受垂直可扩展人工钛肋骨（VEPTR）治疗后的变化，这些变化可能会影响最终的矫正性脊柱融合术。
VEPTR装置最初是为治疗先天性胸廓畸形而研发的，如今在EOSD治疗中应用更为广泛。目前，仅有少数报告描述了VEPTR重复延长手术可能出现的并发症，这使得最终的脊柱融合术更加复杂且效果欠佳。
分析5例接受双侧VEPTR（每侧肋骨至肋骨及肋骨至腰椎椎板）治疗的EOSD患儿在VEPTR治疗前、治疗期间、治疗结束时以及最终脊柱融合术后的X线片，观察其曲线类型和Cobb角。记录脊柱融合术中影响曲线矫正可能性的观察结果。
所有患者在接受VEPTR装置治疗后均出现明显的额状面平衡失代偿，主弯和代偿弯的僵硬程度较高。由于脊柱节段的自发自体融合、肋骨支架和/或椎板钩的移位以及曲线类型的改变，所有患者最终的融合范围均比原发性畸形预期的更长。
如果采用VEPTR治疗EOSD，应密切观察曲线进展情况，尤其是高胸段后凸加重或主弯旋转的情况。肋骨与椎体的自体融合可能会使最终的矫正性脊柱融合术对患者而言更具挑战性和风险，且最终结果也不尽人意。
