Ossifications After Vertical Expandable Prosthetic Titanium Rib Treatment in Children With Thoracic Insufficiency Syndrome and Scoliosis

Groenefeld, Bastian; Hell, Anna K.

doi:10.1097/brs.0b013e318292aafa

Cited by 30 publications

(32 citation statements)

References 28 publications

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“…Two-thirds of our patients showed ossifications, which is a slightly higher rate than previously reported [14]. Half of those ossifications were situated around the anchors.…”

Section: Discussioncontrasting

confidence: 58%

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Extraspinal ossifications after implantation of vertical expandable prosthetic titanium ribs (VEPTRs)

Zivkovic¹,

Büchler

Ovadia

et al. 2014

Journal of Children's Orthopaedics

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IntroductionThough developed for thoracic insufficiency syndrome, the spinal growth-stimulating potential and the ease of placement of vertical expandable titanium ribs (VEPTRs) has resulted in their widespread use for early-onset spine deformity. Observation of implant-related ossifications warrants further assessment, since they may be detrimental to the function-preserving non-fusion strategy.Patients and methodsRadiographs (obtained pre and post index procedure, and at 4-year follow-up) and the records of 65 VEPTR patients from four paediatric spine centres were analysed. Ossifications were classified as type I (at anchor points), type II (along the central part) or type III (re-ossification after thoracostomy).ResultsThe average age at the index procedure was 6.5 years (min 1, max 13.7). The most prevalent spine problem was congenital scoliosis (37) with rib fusions (34), followed by neuromuscular and syndromic deformities (13 and 8, respectively). Idiopathic and secondary scoliosis (e.g. after thoracotomy) were less frequent (3 and 4, respectively). Forty-two of the 65 (65 %) patients showed ossifications, half of which were around the anchors. Forty-five percent (15/33) without pre-existing rib fusions developed a type II ossification along the implant. Re-ossifications of thoracostomies were less frequent (5/34, 15 %). The occurrence of ossifications was not associated with patient-specific factors.ConclusionsImplant-related ossifications around VEPTR are common. In contrast to harmless bone formation around anchors, ossifications around the telescopic part and the rod section are troublesome in view of their possible negative impact on chest cage compliance and spinal mobility. This potential side effect needs to be considered during implant selection, particularly in patients with originally normal thoracic and spinal anatomy.

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“…Two-thirds of our patients showed ossifications, which is a slightly higher rate than previously reported [14]. Half of those ossifications were situated around the anchors.…”

Section: Discussioncontrasting

confidence: 58%

“…However, there is a paucity of literature on those topics. Groenefeld and Hell recently claimed that the radiographic occurrence of ossification rose continuously up to 48 % at 53 months after the index procedure in a single-centre study of 57 VEPTR patients [14]. …”

Section: Introductionmentioning

confidence: 99%

Extraspinal ossifications after implantation of vertical expandable prosthetic titanium ribs (VEPTRs)

Zivkovic¹,

Büchler

Ovadia

et al. 2014

Journal of Children's Orthopaedics

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“…Fusions of the ribs after VEPTR procedures have been documented and were found in our patient; this was likely the reason why the lengthening procedures failed to improve his thoracic volume. This finding is consistent with those of previous publications [12,13].…”

Section: Discussionsupporting

confidence: 83%

Sagittal Distraction of the Sternum in a Juvenile Male with Severe Short Rib Syndrome and Thoracic Insufficiency Syndrome - A Case Report

Kibsgård¹

2017

MOJOR

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Background: This report describes a case of thoracic insufficiency/short rib syndrome treated with sagittal distraction of the sternum in a juvenile male.Methods: An acute increase in the thoracic cage volume was achieved in an 8-year-old male with thoracic insufficiency syndrome by sternum splitting and distraction of 3 centimeters. He had previously been treated with bilateral opening wedge and thoracic vertical expandable prosthetic titanium rib instruments. At 8 years, his respiration was rapidly deteriorating, and posterior revision surgery with resection of the posterior wall at this stage had no further positive influence on his respiratory function. Two years later, a second distraction of the sternum and acute distraction were performed as part of the thoracic expansion procedure. Results:The procedure resulted in an increase in his respiratory functions, and his pulmonary artery parameters decreased to normal values. His clinical condition improved, and after surgery, he could ride a bicycle to school and even participate in sports, such as cross-country skiing and soccer. Conclusion:Short rib syndrome presenting with respiratory failure in a neonate is potentially fatal without surgical intervention to expand the thoracic cage. Our patient had severe thoracic insufficiency syndrome and experienced clinical improvement from the procedure. Sternum distraction has been previously used in neonates, but to the best of our knowledge, this is the first distraction of the sternum addressing short rib syndrome in a juvenile.

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“…For example, the vertical expandable prosthetic titanium rib is indicated for treatment of thoracic insufficiency syndrome in skeletally immature patients. 26 Though subsequent follow-up studies suggested modest effect on lung function 27 and a possible increased risk of ossification, 28 the device has been valuable as a first step in spinal correction and improvement of quality of life for children with thoracic insufficiency syndrome and related disorders. 29 30 Other devices approved through the HDE pathway have been controversial.…”

Section: Performance Of Humanitarian Devicesmentioning

confidence: 99%

Assessment of US pathway for approving medical devices for rare conditions

Hwang

Carpenter

Kesselheim

2014

BMJ

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Ossifications After Vertical Expandable Prosthetic Titanium Rib Treatment in Children With Thoracic Insufficiency Syndrome and Scoliosis

Abstract: 3.

Cited by 30 publications

References 28 publications

Extraspinal ossifications after implantation of vertical expandable prosthetic titanium ribs (VEPTRs)

Extraspinal ossifications after implantation of vertical expandable prosthetic titanium ribs (VEPTRs)

Sagittal Distraction of the Sternum in a Juvenile Male with Severe Short Rib Syndrome and Thoracic Insufficiency Syndrome - A Case Report

Assessment of US pathway for approving medical devices for rare conditions

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