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Title: VEPTR Implantation to Treat Children With Early-Onset Scoliosis Without Rib Abnormalities: Early Results From a Prospective Multicenter Study

Authors: El-Hawary R, Kadhim M, Vitale M, Smith J, Samdani A, Flynn JM; Children’s Spine Study Group.

Journal: Journal of Pediatric Orthopaedics

Date: December 01, 2017

Excerpt: This prospective, multicenter study reports 2-year results of patients with early onset scoliosis (EOS) without rib abnormalities treated with VEPTR. The study showed improvement in scoliosis and thoracic spinal growth over the course of treatment.

Keywords: VEPTR; Early-onset scoliosis; Spinal growth

Summary:

What is the purpose of this study?

The aim of this study was to evaluate the efficacy of VEPTR in preventing further progression of scoliosis without stopping spinal growth in children with progressive EOS without rib abnormalities.

 

RESULTS

  • 63 patients (28 females, 35 males) were studied. Average age of initial VEPTR implant was 6.1 +/- 2.4yrs.
  • Etiologies included congenital (n=6), neuromuscular (n=36), syndromic (n=4), and idiopathic (n=17).
  • Scoliosis (72±18 degrees) decreased after implant surgery (47±17 degrees) followed by slight increase at 2-year follow-up (57±18 degrees), P<0.0001. Kyphosis (48±22 degrees) also showed significant decrease after implantation (40±14 degrees), but increased after 2 years (48±16 degrees), P<0.0001.
  • Coronal spine height measurements showed significant increases after implantation surgery and at 2 years, P<0.0001. The increase in coronal spine height represented 144% of expected age-matched T1-T12 growth and 193% of expected age-matched T1-S1 growth. The instrumented spine segment continued growth after implantation to 2-year follow-up, P<0.0001.

Discussion Points

  • At 2-year follow-up, VEPTR was effective in treating EOS without rib abnormalities with 86% of patients having an improvement in scoliosis and 94% of patients having an increased spinal height as compared with preoperative values. The effect of curve correction was maximum at initial implantation.
  • During the distraction phase, VEPTR instrumentation continues to allow the spine to grow. This amount of growth represents about 40% for T1-T12 and 31% for T1-S1 spine of the expected age-matched growth based on Dimeglio reference numbers. This is important as it proves continuous spine growth with VEPTR treatment.