Treatment of congenital thoracic scoliosis with associated rib fusions using VEPTR expansion thoracostomy: a surgical technique

Dayer, Romain; Ceroni, Dimitri; Lascombes, P.

doi:10.1007/s00586-014-3338-3

Cited by 21 publications

(9 citation statements)

References 36 publications

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“…The correction rate of SK was 63.6%. In other studies, the correction rate of SK ranged from 63 to 81.9% [6,8,20,22]. In this study, SK improved with a correction rate of 61.9% at the final follow-up, which was consistent with the findings of previous studies.…”

Section: Discussionsupporting

confidence: 92%

“…Early surgical intervention can mitigate deformity progression and psychological stress [3]. Surgical treatment modalities include in situ posterior spinal fusion, combined anterior and posterior in situ spinal fusion, hemivertebra resection [4], and guided growth procedures such as growing rods [5], Vertical Expandable Prosthetic Titanium Rib (VEPTR, SYNTHES Spine) [6], and Shilla [7] procedures.…”

Section: Introductionmentioning

confidence: 99%

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Posterior thoracolumbar hemivertebra resection and short-segment fusion in congenital scoliosis: surgical outcomes and complications with more than 5-year follow-up

Bao

Hai

et al. 2021

BMC Surg

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Background Treatment of congenital hemivertebra is challenging and data on long-term follow-up (≥ 5 years) are lacking. This study evaluated the surgical outcomes of posterior thoracolumbar hemivertebra resection and short-segment fusion with pedicle screw fixation for treatment of congenital scoliosis with over 5-year follow-up. Methods This study evaluated 27 consecutive patients with congenital scoliosis who underwent posterior thoracolumbar hemivertebra resection and short-segment fusion from January 2007 to January 2015. Segmental scoliosis, total main scoliosis, compensatory cranial curve, compensatory caudal curve, trunk shift, shoulder balance, segmental kyphosis, and sagittal balance were measured on radiographs. Radiographic outcomes and all intraoperative and postoperative complications were recorded. Results The segmental main curve was 40.35° preoperatively, 11.94° postoperatively, and 13.24° at final follow-up, with an average correction of 65.9%. The total main curve was 43.39° preoperatively, 14.13° postoperatively, and 16.06° at final follow-up, with an average correction of 60.2%. The caudal and cranial compensatory curves were corrected from 15.78° and 13.21° to 3.57° and 6.83° postoperatively and 4.38° and 7.65° at final follow-up, with an average correction of 69.2% and 30.3%, respectively. The segmental kyphosis was corrected from 34.30° to 15.88° postoperatively and 15.12° at final follow-up, with an average correction of 61.9%. A significant correction (p < 0.001) in segmental scoliosis, total main curve, caudal compensatory curves and segmental kyphosis was observed from preoperative to the final follow-up. The correction in the compensatory cranial curve was significant between preoperative and postoperative and 2-year follow-up (p < 0.001), but a statistically significant difference was not observed between the preoperative and final follow-up (p > 0.001). There were two implant migrations, two postoperative curve progressions, five cases of proximal junctional kyphosis, and four cases of adding-on phenomena. Conclusion Posterior thoracolumbar hemivertebra resection after short-segment fusion with pedicle screw fixation in congenital scoliosis is a safe and effective method for treatment and can achieve rigid fixation and deformity correction.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Posterior thoracolumbar hemivertebra resection and short-segment fusion in congenital scoliosis: surgical outcomes and complications with more than 5-year follow-up

Bao

Hai

et al. 2021

BMC Surg

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“…6 Untreated growing patients with congenital scoliosis and fused ribs can develop thoracic insufficiency syndrome in serious cases. 7 Congenital scoliosis with associated rib fusions, thoracic syndrome, and hypoplastic thorax can create progressive three-dimensional deformity of the chest, inhibiting normal lung growth and respiratory function, leading to respiratory failure. 8 Adolescent Idiopathic Scoliosis (AIS) is a structured lateral curve of the spine of undetermined cause that occurs between 10 and 18 years of age and is not associated with fusion of the costal arcs.…”

Section: Discussionmentioning

confidence: 99%

Costal Malformation Related to Thoracolumbar Scoliosis in Adolescents - Case Report

Guimarães

Pinheiro²,

Vasconcelos³

et al. 2018

Coluna/Columna

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Congenital scoliosis associated with costal malformation is well known. However, there are no reports of idiopathic scoliosis associated with the fusion of the costal arcs in the literature. This report describes a case of idiopathic scoliosis with fusion of the 1st and 2nd costal arches in a female patient and reports changes in the deformity due to scoliosis because of the treatment. The analysis was performed from a morphological and clinical point of view, and by complementary tests. Radiographs and CT scans were obtained and evaluated from the first consultation in 2012 and during the period in which the patient was followed in a private clinic, until the stabilization of the condition, in 2014. The evolution was favorable with the use of a Milwaukee vest and there was improvement of the clinical picture after the skeletal maturity, and the angle of lateral curvature, measured by the Cobb method, initially of 20 degrees, was reduced and stabilized in nine degrees, measure which is currently maintained. The analysis showed concomitant pathologies, and the fusion of costal arches did not influence the spine deformity, since there was regression with the clinical treatment. This evolution leads us to conclude that adolescent idiopathic scoliosis should be imputed as the sole responsible for the clinical picture of the patient, and that the fusion of the costal arches does not interfere with the biomechanics of the spine. Level of Evidence: IV. Type of study: Case series.

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“…[5] Traditional “growing rods” utilize anchors on the spine, both cephalad and caudal to the curve apex. More recently, the use of ribs as cephalad anchor sites has been described as a hybrid to the traditional system.…”

Section: Introductionmentioning

confidence: 99%

Biomechanical Evaluation of a Growth-Friendly Rod Construct

et al. 2017

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Background Distraction type rods mechanically stabilize the thorax and improve lung growth and function by applying distraction forces at the rib, spine, pelvis, or a combination of locations. However, the amount of stability the rods provide and the amount the thorax needs is unknown. Methods Five freshly frozen and thawed cadaveric thoracic spine specimens were tested lateral bending, flexion/extension, and axial rotation in displacement control (1°/sec) to a load limit of ± 5 Nm for five cycles after which a growth-friendly unilateral rod was placed in a simulated rib-to-lumbar attachment along the right side. The specimens were tested again the same modes of bending. From the seven Optotrak Orthopedic Research Pin markers (Northern Digital Inc., Waterloo, ON, Canada) inserted into the top potting to denote T1, and the right pedicles at T2, T4, T5, T8, T9, and T11 and the Standard Needle Tip Pressure Transducers (Gaeltech, Isle of Skye, Scotland) inserted into the T4/T5 and T8/T9 discs, motion, stiffness, and pressure data were calculated. Parameters from the third cycle of the intact case and the construct case were compared using two-tailed paired t-tests with 0.05 as the level of significance. Results With the construct attached, the T1–T4 segment showed a 30% increase in NZS during extension (p = 0.001); the T8–T12 segment experienced a 63% reduction in the in-plane ROM during flexion (p = 0.04); and the T8/T9 spinal motion unit had a significant decrease of 24% in EZS during left axial rotation (p = 0.04). Conclusions It’s clear the device as tested here does not produce large biomechanical changes, but the balance between providing desired changes while preventing complications remains difficult. Clinical Relevance Investigating the biomechanical effect growth-friendly rods have on the thoracic spine could lead to better understanding of treatment outcomes, both positive and negative.

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Treatment of congenital thoracic scoliosis with associated rib fusions using VEPTR expansion thoracostomy: a surgical technique

Cited by 21 publications

References 36 publications

Posterior thoracolumbar hemivertebra resection and short-segment fusion in congenital scoliosis: surgical outcomes and complications with more than 5-year follow-up

Posterior thoracolumbar hemivertebra resection and short-segment fusion in congenital scoliosis: surgical outcomes and complications with more than 5-year follow-up

Costal Malformation Related to Thoracolumbar Scoliosis in Adolescents - Case Report

Biomechanical Evaluation of a Growth-Friendly Rod Construct

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