ASSESSMENT OF THE VEPTR SYSTEM IN MANAGEMENT OF SPINAL DEFORMITIES IN THE ROOSEVELT CHILDREN’S ORTHOPEDICS INSTITUTE BETWEEN JANUARY 2008 AND MAY 2014

Laura Montoya-Sánchez

Resumo


Introduction: There are multiple methods included in management of congenital and neuromuscular scoliosis in underage patients. Traditional surgical treatments, such as on-site fusion and hemiepiphysiodesis, have not addressed the thoracic deformity in its three dimensions, and usually turn out insufficient and unpredictable. The application of Vertical Expandable Prosthetic Titanium Rib (VEPTR) is a technique developed to treat early onset progressive scoliosis. This vertically placed device uses distraction to indirectly elongate the spine and thorax wall, allowing an adequate lung development. Materials and methods: we carried out a case series retrospective study. We included 23 patients, including fifteen females and eight males diagnosed with congenital and neuromuscular scoliosis, who were treated with VEPTR type implants between January 2008 and May 2014. We obtained data about the implant; pre and postoperative radiographic images to assess the magnitude of the curve, and we measured the Cobb angle and length after lengthening, as well as evaluating the complications found. Results: our results showed improvement in the postoperative Cobb angle. In minors with congenital scoliosis, deformity correction was 8.6% (p=0.014), and in neuromuscular scoliosis we observed a deformity correction of 19.5% (p=0.009). Likewise, we found gains in thoracic height through the device, which results in an average 10% elongation of the spine in congenital scoliosis. In this study, we identified complications such as material migrations, rib synostosis, pressure zones, rib fracture, hemothorax, and deep wound infection. Discussion: data analysis shows that the natural history of the progressive spinal deformity improved in most of the minors through theuse of VEPTR. This allows us to continue managing patients in the future, in order to make a deeper assessment of its performance in treatment of early onset scoliosis.