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Title: VEPTR Implantation After Age 3 is Associated with Similar Radiographic Outcomes With Fewer Complications

Authors: Upasani VV1, Miller PE, Emans JB, Smith JT, Betz RR, Flynn JM, Glotzbecker MP; Children’s Spine Study Group

Journal: J PediatrOrthop. 36(3):219-25.

Date: May 01, 2016

Excerpt: This study looks at the risks and benefits of implanting the VEPTR device in children age three and under compared to those who had the delayed device implantation, from age three to age six. A total of 71 patients were included in this study and were followed at least five years after device implantation. Important notes: The specific reason VEPTR surgery was recommended was not considered in this paper and was sure to vary among each patient. In addition, pulmonary function data was NOT reviewed or included in this study.

Keywords: Complications, Early Onset Scoliosis, Growth Friendly Surgery

Summary:

What is the purpose of this study?

When to implant the VEPTR device has been a debatable topic amongst experts for some time, the goal of this paper is to analyze the risks, benefits, and outcomes of children who have the VEPTR device implanted before age three compared those who had the device implanted after age three.

 

RESULTS

Patients In Both Groups

  • Had similar diagnoses
  • Had a comparable number of lengthenings
  • Had no significant difference in curve measurement before surgery
  • X-ray measurements throughout followup were comparable
  • Overall device related complications were comparable to both groups
  • Rate of complication was comparable for just the first two years after implantion.
  •  

Early VEPTR Intervention Group

  • Total of 118 complications
  • 63% of total complications were medical complications
  • Higher number of device complications that required surgical intervention sooner than the next scheduled lengthening or complete change was needed to overall treatment plan
  • Significantly higher number of complications per lengthening
  • Complication rate rose significantly after 40 months from implantation

Delayed VEPTR Intervention Group

  • Total of 69 complications
  • 33% of total complications were medical complications
  • Higher number of device complications that could be addressed at next scheduled lengthening
  • 41% fewer complications per lengthening

 

Important Discussion Points

  • Timing for surgical intervention is still debated
  • Early intervention may make device implantation easier and may promote lung development and function
  • Delayed intervention may decrease number of lengthenings and anesthesia exposure along with better anchoring of the device because of better bone quality in older kids.
  • While the early intervention group had a significantly higher rate of implant related complications, it is unclear if this was related to the size of the device being mismatched compared to the anatomy of a smaller, younger child or if it was related to the faster and greater spinal growth associated with young children.
  • Pulmonary function data was not reviewed or included in this study.
  • Bracing, casting, or isolated surgical procedures should be discussed as a way to delay VEPTR implantation.
  • Ultimately the decision to intervene surgically and when to intervene has to be individualized for each patient.