Amer F. Samdani, MD Tricia St. Hilaire John Emans, MD John Smith, MD

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Presentation transcript:

The Utility of VEPTR in the Older Child with Complex Spine and Chest Deformity Amer F. Samdani, MD Tricia St. Hilaire John Emans, MD John Smith, MD Kit Song, MD Robert Campbell, MD Randal R. Betz, MD ( Chest Wall and Spine Deformity Study Group, Synthes Spine, and AO Spine North America )

Disclosures RM Campbell Grant Support NORD, FDA Office of Orphan Product Development Royalites Synthes Spine Co

Background Main indication for titanium rib surgery: to increase lung volume in patients < age 8 What options exist to correct the complex congenital spine and chest wall deformity in older children?

Significance Correction of congenital spine deformity in patients over 10 remains a challenge. Vertebral column resection is an option but has a high neurological risk and is technically demanding.

Wedge Osteotomies

16 yo old with complex cervical thoracic congenital scoliosis

Purpose To analyze the radiographic spine deformity correction following treatment with VEPTR implants in a group of older children (> age 10) at time of first surgery

Methods Retrospective study of patients who participated in FDA IDE study who: have had VEPTR surgery were over 10 yrs of age at initial surgery have minimum 2 yr follow-up

Methods Of 214 total patients in database, 10 met the inclusion criteria Mean age at surgery: 12.4 years Diagnoses: Congenital scoliosis = 6 Hypoplastic thorax = 3 Myelomeningocele = 1 4 had prior limited spine fusion

Methods Radiographic measurements Hemithoracic height and width Maximum Cobb angle Hemithoracic height and width Thoracic height Head shift T1 tilt angle

Pre/Post Cobb Correction Pre/Post Head Shift (cm) Results Diagnosis N Pre/Post Cobb Correction 2 yr Cobb Correction Pre/Post Head Shift (cm) Definitive Procedure Congenital Scoliosis with or without Fused Ribs 6 36.4% 32.1% 4.3 Posterior spinal fusion (n=2); planned for fusion (n=2); no fusion planned (n=2) Hypoplastic Thorax 3 15.9% -4.7% 1.8 Posterior spinal fusion (n=1); planned for fusion (n=2) Myelomeningocele 1 12.7% -16.4% 7.9 Posterior spinal fusion (n=1)

Complications No patient sustained a neurologic injury One patient with device fracture and migration One patient with pain in the upper lumbar spine Two patients with pneumonia

Age 10, congenital scoliosis July 2002 March 2005

The Effect of Mid-Thoracic VEPTR Opening Wedge Thoracostomy on Cervical Tilt associated with Congenital Scoliosis SPINE 2007 RM Campbell, Jr., MD BM Adcox, MD MD Smith, MD, JW Simmons III, DO, BR Cofer, MD, SC Inscore, MD, C Grohman, RN Avg Age 4.4 yrs

Summary This study demonstrated the safety and utility of VEPTR in carefully selected older patients with complex spine and chest wall deformities. VEPTR may be a viable option for these children when vertebral column resection is deemed too risky.

Thank You