REALLY? WAS THIS SUPPOSED TO BE A DEBATE?

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Presentation transcript:

REALLY? WAS THIS SUPPOSED TO BE A DEBATE? SPINE vs. CHEST REALLY? WAS THIS SUPPOSED TO BE A DEBATE?

WHO IS THIS GUY? VEPTR ASSASSIN

I HAVE EXPERIENCED BOTH SIDES VEPTR- OKLAHOMA Dr. Puffinbarger Trained by David Roye GR- SAN DIEGO Dr. Akbarnia GR MASTER EXTRAORDINAIRE

EASING MY WAY INTO ACADEMIA

EASING MY WAY INTO ACADEMIA vs. PC

So what about the “debate”? The Problem: Symptomatic Decreased Lung Volume Progressive Spinal Deformity

CHEST WALL PROBLEM? VEPTR NO! THIS IS A SPINE DEFORMITY PROBLEM LEADING TO PULMONARY COMPROMISE VEPTR

NOT ARGUING ABOUT THIS PATIENT

The case for the GROWING ROD

Low lung volume + Asymmetric lung function Diapragm inefficiency Redding ICEOS 2009 Low lung volume + Asymmetric lung function Diapragm inefficiency Diaphragm dysfunction in light of lock box. SO now you have taken away the compensatory mechanism of these children

COMPLICATIONS Wound related Implant related Alignment Learning curve issues Medical complications High in both VEPTR and Growing rods Well established in literature

COMPLICATIONS Growing Rod VEPTR Neuro deficits Distraction problem Introperative recognition Shorten Remotely? Pedicle screw problem Don’t use them Use 4 hooks and cross connector SERIOUS WOUND PROBLEMS -VEPTR II Brachial plexopathy is MAJOR problem

Cambell et al SPINE 2007 Brachial Plexopathy

Cadeveric dissection demonstrates the brachial plexus draping over the first rib. White arrow shows a VEPTR cradle on the first rib – rib anchors on the first rib alone should be avoided. (reproduced with permission of Children’s Orthopaedic Center, Los Angeles

WHY RISK THE OCCURRENCE OF THIS???

DEFORMITY CORRECTION

GROWING RODS 56%  64% 53%

Correction of deformity???

Bilateral use of the vertical expandable prosthetic titanium rib attached to the pelvis: a novel treatment for scoliosis in the growing spine. Samdani AF, Ranade A, Dolch HJ, Williams R, St Hilaire T, Cahill P, Betz RR. Shriners Hospital for Children, Philadelphia, Pennsylvania 19140, USA. amersamdani@yahoo.com 28% 81°51°58°

And I quote…

SAGITTAL PLANE PROBLEMS

KYPHOSIS This is a spine problem not CHEST Go to where the money is…the SPINE

50°35°45°

VEPTR= kyphosis generator 23° post op 37° (25 mo later) Bilateral use of the vertical expandable prosthetic titanium rib attached to the pelvis: a novel treatment for scoliosis in the growing spine. Samdani AF, Ranade A, Dolch HJ, Williams R, St Hilaire T, Cahill P, Betz RR. Shriners Hospital for Children, Philadelphia, Pennsylvania 19140, USA. amersamdani@yahoo.com VEPTR= kyphosis generator 23° post op 37° (25 mo later)

Without fusion group: Overall Kyphosis-

“Mild increase in kyphosis” over 2 year follow up. from 23°  36°!!! Hey Lincoln, What do you think of those stats? “Mild increase in kyphosis” over 2 year follow up. from 23°  36°!!! Over avg 25 mo follow up Isn’t that progressive THAT’S 50% MORE!!!! ISN’T THAT PROGRESSIVE DADDY?

NOT FINAL FOLLOW UP JUST ICEOS 2009- CWSG (Vitale) Hyperkyphosis pts -avg start 70° -reduced to mid 50°s -final 75° NOT FINAL FOLLOW UP JUST 42 mo

KYPHOSIS In a pole by Dr. Sponseller on 11/20/2009 this very audience showed a “preponderance” for GROWING RODS

I HAVE ACTED CRAZY AT TIMES

BUT… …THIS IS NOT ONE OF THEM

But VEPTR improves QOL… Right?

WRONG

History Deformity progression at 12 and 30 months age 12 months old

22 months post-op

Can’t Wait to show this one to Bob!!!

For the love of everything HOLY…DON’T do this to me!!!! Lincoln, Uncle Bob wants to “give” you a VEPTR!

Hey Lincoln, Papa Behrooz wants to bless you with dual GROWING RODS!!! Oh Thank you Papa Behrooz for DOING THE RIGHT THING

MAC’s RULE