Vertical Expandable Prosthetic
Titanium Rib (VEPTR):
Indications, Technique,
and Management Review
Shailja C. Shah, B.S.
Medical Student
Drexel University College of Medicine
Philadelphia, PA
John K. Birknes, M.D.
Spine Fellow
Shriners Hospital for Children
Philadelphia, PA
Sukh Sagoo, M.D.
Resident
Department of Orthopedics
Shriners Hospital for Children
Philadelphia, PA
Shelby Thome, B.A.
Research Associate
Shriners Hospital for Children
Philadelphia, PA
Amer F. Samdani, M.D.
Director
Pediatric Spine Service
Shriners Hospital for Children
Philadelphia, PA
Surgical correction is generally indicated as the primary form of management in children with severe early onset scoliosis. Even so, conservative, nonsurgical treatment is always considered first, as surgical correction carries significant concomitant consequences, including but not limited to crankshaft phenomenon and, more importantly, inhibition of further spine, lung, and chest growth in skeletally immature patients. Fusionless surgical procedures assuage some of these risks, as they are characteristically associated with techniques necessitating spinal fusion. One device looks particularly promising in treating and managing severe early onset scoliosis, the vertical expandable prosthetic titanium rib (VEPTR)-a device that was initially targeted toward children with thoracic insufficiency syndrome (TIS). Despite its promising results in correction of severe early onset scoliosis, as well as associated rib and chest wall deformities, the VEPTR nevertheless has a complication rate comparable to other fusionless techniques. Continued modifications and research will hopefully beget a device that permits thoracic and spinal growth in skeletally immature patients yet with fewer postoperative complications. In this chapter, the authors review the clinical experience with VEPTR to date and present their results in 16 children with congenital scoliosis cared for at Shriners Hospital of Philadelphia.
