The Effect of Mid-Thoracic VEPTR Opening Wedge Thoracostomy on Cervical Tilt Associated With Congenital Thoracic Scoliosis in Patients With Thoracic Insufficiency Syndrome

Abstract

Mid-thoracic VEPTR opening wedge thoracostomy can stabilize cervical tilt associated with thoracic congenital scoliosis and fused ribs and may be an alternative to cervicothoracic spine fusion or hemi-vertebrectomy in some young children.

The Usefulness of VEPTR in the Older Child With Complex Spine and Chest Deformity

“…In these patients, VEPTR improves the Cobb angle, increases the space available for the lung, and allows for continued growth of the spine. In addition, Campbell and colleagues [1] studied 14 patients with congenital scoliosis with fused ribs and cervical tilt. They demonstrated improved cervical tilt, head shift, and truncal decompensation with VEPTR in these patients.…”

“…Head shift, or head decompensation, was defined as the distance from the center of C7 to the central sacral line [6]. The T1 tilt angle was the angle measured between a line drawn at the superior end plate of T1 and a line drawn perpendicular to the central sacral line [1]. As a result of poor radiographic visibility of all measurements, data were unavailable in two patients.…”

Efficacy and safety of VEPTR instrumentation for progressive spine deformities in young children without rib fusions

“…Two patients (Nos. 4,20) had a more than 10°worse Cobb angle at follow-up than before the IP (14°and 17°, respectively), 16 improved more than 10°.…”

“…T1 tilt and space available for lungs (SALs) ratios [20] were assessed on pre-and post-IP radiographs and at follow-up. SAL ratios of less than 90% and pelvic obliquity and T1 tilt [ 10°were rated pathologic [20]. Diagnosis, pattern of spine deformities, type of construct, changes of strategy, complications and extra-surgeries were recorded.…”

“…Ten patients (Nos. 2,8,9,12,16,17,18,20,22,23) showed a thoracic hyperkyphosis (68°-128°). Six patients were corrected and four stabilised.…”