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John Heflin, Michelle Welborn, Norman Ramirez-Lluch, Ivan Iriarte, Ron El-Hawary, Graham T Fedorak, John T Smith
STUDY DESIGN: Retrospective case control OBJECTIVE.: To report on differences in implant failure rates and complications requiring reoperation in children with early-onset scoliosis (EOS) treated with rib-based distraction utilizing four proximal fixation points in either a parallel or in-line configuration. SUMMARY OF BACKGROUND DATA: Proximal anchor failure continues to be a significant problem in growth-friendly surgery using rib-based distraction to treat children with EOS...
January 8, 2018: Spine
Liam R Harris, Lindsay M Andras, Paul D Sponseller, Charles E Johnston, John B Emans, David L Skaggs
STUDY DESIGN: Multicenter retrospective cohort. OBJECTIVE: To compare improvement in nutritional status seen in early-onset scoliosis (EOS) patients following treatment with various growth-friendly techniques, especially in underweight patients (<20th weight percentile). BACKGROUND: Thoracic insufficiency resulting from EOS can lead to severe cardiopulmonary disease. In this age group, pulmonary function tests are often difficult or impossible to perform...
January 2018: Spine Deformity
Faisal R Jahangiri, Samir Al Sayegh, Moutasem Azzubi, Abdulrahman M Alrajhi, Monerah M Annaim, Shmoukh A Al Sharif, Tanweer Aziz, Sami Al Eissa
Intraoperative neurophysiological monitoring (IONM) consists of a group of neurodiagnostic techniques that assess the nervous system's functional integrity during surgical operations. A retrospective analysis of a pediatric female patient was conducted who underwent 12 operations for the correction of scoliosis, tethered cord, and split spinal cord wherein IONM played an important role. From age 3 to 6, she underwent six procedures including a release of the tethered cord, resection of the filum terminale, removal of a T11-T12 bony spur, release of L3 adhesions, repair of subcutaneous meningocele, and correction of scoliosis with a vertical expandable prosthetic titanium rod (VEPTR) technique without the use of IONM...
2017: Neurodiagnostic Journal
Leonie Wagner, Lena Braunschweig, Helmut Eiffert, Konstantinos Tsaknakis, Dirk Kamin, Elisa D'Este, Philipp K Messer, Anna Kathrin Hell, Heiko M Lorenz
BACKGROUND: Bacterial colonization of spinal implants may cause severe complications in patients with early-onset scoliosis. Correct diagnosis and detection of microbiologic formation is crucial to prevent delayed infections caused by bacterial colonization. The purposes of this study were to estimate the rate and risk factors of colonization of vertical expandable prosthetic titanium rib (VEPTR) implants in children and to compare the different methods for detecting microbiologic formation on the spinal implants...
January 2018: Surgical Infections
Zhonghui Chen, Song Li, Yong Qiu, Zezhang Zhu, Xi Chen, Liang Xu, Xu Sun
OBJECTIVE Although the vertical expandable prosthetic titanium rib (VEPTR) and growing rod instrumentation (GRI) encourage spinal growth via regular lengthening, they can create different results because of their different fixation patterns and mechanisms in correcting scoliosis. Previous studies have focused comparisons on coronal plane deformity with minimal attention to the sagittal profile. In this retrospective study, the authors aimed to compare the evolution of the sagittal spinal profile in early-onset scoliosis (EOS) treated with VEPTR versus GRI...
December 2017: Journal of Neurosurgery. Pediatrics
Andrea S Gantner, Lena Braunschweig, Konstantinos Tsaknakis, Heiko M Lorenz, Anna K Hell
BACKGROUND CONTEXT: In several studies, vertical expandable prosthetic titanium rib (VEPTR) implants have shown good scoliosis control in children with the longest reported follow-up (f/u) of 3.6 years. For growing rods, recent studies suggest a decreased efficiency of correction starting just after that time. To our knowledge, no long-term results of children with VEPTR treatment are available. PURPOSE: To evaluate spinal deformity in scoliotic children and to investigate correction potential of VEPTR implants at several time points of treatment, particularly after long-term f/u...
August 22, 2017: Spine Journal: Official Journal of the North American Spine Society
Kenny Yat Hong Kwan, Jason Pui Yin Cheung, Karen Kar Lum Yiu, Kenneth Man Chee Cheung
PURPOSE: Jarcho-Levin syndrome patients commonly suffer from repeated respiratory infections and become ventilator dependent due to an insufficient thoracic volume. Multiple congenital vertebral anomalies are associated with this genetic disorder and results in stunted spine growth. The purpose of this case report is to present the results of a hybrid vertical expandable prosthetic titanium rib (VEPTR) and magnetically controlled growing rod (MCGR) construct for the management of a patient with Jarcho-Levin syndrome...
June 12, 2017: European Spine Journal
M R Konieczny, A-K Ehrlich, R Krauspe
BACKGROUND: Theoretically, dynamic thoracic compliance (DTC) should be reduced by vertical expandable prosthetic titanium ribs (VEPTR) since titanium rods, scar tissue and ossifications increase stiffness of the rib cage. The effect of VEPTR on thoracic compliance has not yet been elucidated. The impact of VEPTR on the development of sagittal balance has not been fully investigated. PATIENTS AND METHODS: In a retrospective study, we investigated 21 consecutive children who were treated by VEPTR from 2004 to 2011 and three control groups...
2017: Journal of Children's Orthopaedics
Sarah B Nossov, Evan Curatolo, Robert M Campbell, Oscar H Mayer, Sumeet Garg, Patrick J Cahill
BACKGROUND: The assisted ventilation rating (AVR) indicates the degree of external respiratory support required in children with thoracic insufficiency syndrome (TIS) and early onset scoliosis. For skeletally immature patients with TIS, the vertical expandable prosthetic titanium rib (VEPTR) device can be used to improve lung volume and growth. We hypothesized that patients who underwent early thoracic reconstruction by VEPTR treatment had an improved respiratory status. METHODS: Preoperative and postoperative AVR ratings were prospectively collected in a multicenter study group and compared with determine change after VEPTR treatment...
April 10, 2017: Journal of Pediatric Orthopedics
Ying Li, Maksim A Shlykov, Christopher B Robbins, Frances A Farley, Michelle S Caird, Michelle C Burke
STUDY DESIGN: Prospective comparative study. OBJECTIVE: To evaluate whether weight percentile (WP) increases after vertical expandable prosthetic titanium rib (VEPTR) insertion, and whether WP correlates with nutrition laboratories and pulmonary function. SUMMARY OF BACKGROUND DATA: Children with thoracic insufficiency syndrome often have "failure to thrive" (WP ≤5). Previous authors have reported an increase in WP after VEPTR surgery...
December 1, 2017: Spine
Jaren LaGreca, Tara Flynn, Patrick J Cahill, Amer Samdani, Michael G Vitale, Ron El-Hawary, John T Smith, Jonathan H Phillips, John M Flynn, Michael Glotzbecker, Sumeet Garg
BACKGROUND: The purpose of this study was to determine the rate of intraoperative neurological monitoring (IONM) alerts and neurological injury during vertical expandable prosthetic titanium rib (VEPTR) treatment and evaluate the utility of IONM during VEPTR expansion procedures in patients who have not previously had neurological injury or IONM alerts. METHODS: After institutional review board approval, VEPTR procedures and IONM records were reviewed at 17 institutions for patients treated with VEPTR from 2005 to 2011...
December 2017: Journal of Pediatric Orthopedics
Martí Pons-Odena, Alba Verges, Natalia Arza, Francisco José Cambra
Jarcho-Levin syndrome is a rare disorder characterised by defects in vertebral and costal segmentation of varying severity. Respiratory complications are the main cause of death or severe comorbidity due to a restrictive rib cage. A 3 months old infant with Spondylocostal dysostosis and associated bronchomalacia experiencing severe asynchrony during the weaning process is reported. The Neurally Adjusted Ventilatory Assist (NAVA) mode was used to improve adaptation to mechanical ventilation after Vertical Expandable Prosthetic Titanium Ribs (VEPTRs) were implanted...
February 14, 2017: BMJ Case Reports
Ron El-Hawary, Muayad Kadhim, Michael Vitale, John Smith, Amer Samdani, John M Flynn
BACKGROUND: Thoracoplasty and insertion of vertical expandable prosthetic titanium rib (VEPTR) for thoracic and spine distraction has been found to be effective in the treatment of early-onset scoliosis (EOS) with ribs anomalies and congenital vertebral anomalies. The aim of this study was to evaluate the efficacy of VEPTR in preventing further progression of scoliosis without impeding spinal growth in children with progressive EOS without rib abnormalities. METHODS: This is a prospective, multicenter, observational cohort study...
December 2017: Journal of Pediatric Orthopedics
John T Smith
BACKGROUND: Congenital gibbus deformity of the spine associated with myelodysplasia is a challenging problem in the growing child and is commonly associated with skin breakdown and chronic infection. Surgical solutions including kyphectomy, flap closure of the skin, and early spinal fusion are associated with a high rate of complications and, ultimately, a short trunk due to stoppage of spinal growth. The purpose of this article is to describe our early results in using a rib-based distraction to the pelvis without vertebral resection and fusion to manage this deformity...
January 2016: Spine Deformity
Sumeet Garg, Micaela Cyr, Tricia St Hilaire, Tara Flynn, Patrick Carry, Michael Glotzbecker, John T Smith, Jeffrey Sawyer, Joshua Pahys, Scott Luhmann, John M Flynn, Ron El-Hawary, Michael Vitale
STUDY DESIGN: Retrospective review. OBJECTIVES: To describe clinical characteristics and infection rates in modern vertical expandable prosthetic titanium rib (VEPTR) surgery. SUMMARY OF BACKGROUND DATA: Prior studies have demonstrated infection rates from 10% to 30% with VEPTR surgery. METHODS: A retrospective query was done on an institutional review board-approved, multicenter prospectively collected database for patients implanted with VEPTR from 2007 to 2013 at eight sites...
January 2016: Spine Deformity
John H T Waldhausen, Greg Redding, Klane White, Kit Song
PURPOSE: This report describes complications using the vertical expandable prosthetic titanium rib (VEPTR) for thoracic insufficiency syndrome (TIS) at a single center. METHODS: This is a prospective cohort evaluating 65 patients with rib-rib and rib-spine VEPTR devices for TIS placed between 10/2001 and 11/2014, for children with spinal or chest wall deformity. Patients were classified using the early onset scoliosis classification system (C-EOS). RESULTS: 65 patients are available for follow up...
November 2016: Journal of Pediatric Surgery
Friederike Lattig, Rita Taurman, Anna K Hell
STUDY DESIGN: Case Series. OBJECTIVE: 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. SUMMARY OF BACKGROUND DATA: 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...
June 2016: Clinical Spine Surgery
Constantin Gomes, Mathieu Kuchenbuch, Grégory Lucas, Soizic Argaud, Philippe Violas, Paul Sauleau
PURPOSE: To assess the validity and utility of monopolar stimulation (between a peridural needle and a large adhesive anode placed in the sternal area) for intraoperative monitoring in scoliosis surgery. METHODS: This procedure was assessed during 41 operations involving either arthrodesis with posterior instrumentation or a Vertical Expandable Prosthetic Titanium Rib (VEPTR). Responses evoked by monopolar stimulation were compared with those evoked by bipolar stimulation between two epidural needle electrodes...
October 2016: European Spine Journal
Hans-Rudolf Weiss, Marc Moramarco
Congenital scoliosis is a lateral deformity of the spine with a disturbance of the sagittal profile caused by malformations of vertebra and ribs. Typically, early surgical intervention is the suggested treatment (before three-years-old) for young patients with congenital scoliosis. While a previous study was conducted in 2011 to investigate long-term studies supporting the necessity for this recommendation and no evidence was found, this current review, is an updated search for evidence published from 2011 through March 2015...
2016: Current Pediatric Reviews
Oscar Mayer, Robert Campbell, Patrick Cahill, Gregory Redding
Thoracic insufficiency syndrome (TIS) is a broad grouping of disorders that have a substantial impact on the chest wall, spine, and in many situations, both. While the conditions are varied, they share a potentially substantial impact on respiratory capacity and development over time and a presentation and need for intervention that is often in early childhood. Addressing these conditions has required a new paradigm that involves both deformity correction and a preservation of growth capacity. While there are now a number of options to treat severe spinal deformity early in life, when the deformity causes or is caused by a chest wall deformity, the Vertical Expandable Prosthetic Titanium Rib(VEPTR) is able to support surgical correction of both...
March 2016: Current Problems in Pediatric and Adolescent Health Care
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