Problems and complications in VEPTR-based treatment.

AIM OF THE STUDY: Early-onset scoliosis with co-existing thoracic deformity is particularly difficult to treat, with early surgery usually being the only rational solution. Operative correction of the deformed spine and rib cage employs techniques enabling further growth of the structures, an example of which is the Vertical Expandable Prosthetic Titanium Rib (VEPTR), designed to provide dynamic stabilization of the spinal column and the thoracic cage. Our study aimed to present difficulties and complications related to VEPTR-based operative reduction of the spinal and thoracic deformities in the youngest child.

MATERIAL AND METHODS: Twelve children aged 3 to 9 years (a mean age of 5.25 years) underwent sequential VEPTR-based surgery the Department of Paediatric Orthopaedics of the Medical University of Lublin. The subjects were qualified for the procedure on account of multiple congenital spine deformities (3 children), early-onset progressive neuromuscular scoliosis (4 children) and kyphosis secondary to a myelomeningocele (5 children). The number of procedures per child ranged from 4 to 10 and the follow-up was 10 months to 4 years (with a mean of 2.5 years). Treatment failures and complications comprised rib fractures (4 cases), perforation of the iliac ala by the ala hook (5 cases), pulmonary oedema (2 cases), hip joint destabilization (1 case), tissue reaction to the metal (4 cases), breakage of the implant (2 cases).

RESULTS AND CONCLUSIONS: The specific character of the method makes it liable to a variety of difficulties and complications that may sometimes affect the outcome. Both the authors' experience and published data prove the clinical effectiveness of VEPTR. Nevertheless, it is only a temporary means that cannot disturb the strategic anatomical elements of the spine which are to be involved in subsequent conventional operative procedures. An awareness of the limitations and possible difficulties connected with VEPTR allows for some modifications with which the technique continues to be the most effective sequential treatment of thoracic and spinal deformities in the youngest child.