Long term outcome of vertical expandable prosthetic titanium rib treatment in children with early onset scoliosis

The vertical expandable prosthetic titanium rib (VEPTR) device was originally developed for the treatment of thoracic insufficiency syndrome with the aim of improving respiratory function of affected patients. Although clinically obvious, the changes in pulmonary function of VEPTR-treated patients are difficult to assess when using common lung function tests, and newer techniques based on functional magnetic resonance imaging (MRI) are currently being evaluated. The potential of improving lung function and simultaneously controlling the spinal deformity has continuously broadened the spectrum of indications for VEPTR, not least due to the frequent reports of complications with spine-based traditional growing rods (tGR). However, the initial enthusiasm of spine-sparing deformity correction has progressively subsided with the increasing number of reports on complications, including the detection of extraspinal ossifications along the implants and across ribs. The avoidance of repetitive surgical implant lengthening with the availability of motorized distraction-based implants has further diminished the use of VEPTR, especially in the absence of volume-depletion deformities of the thorax. In view of the still scarce reporting on the ultimate strategy of VEPTR treatment and the lack of long-term follow-up of patients receiving growth-sparing surgery, only limited conclusions can be drawn so far. Based on the available reports, however, the intended deformity corrections with final fusion surgeries can be achieved to a rather limited extent, while the complication and reoperation rates are still very high.