VEPTR Implantation for Children with congenital scoliosis under Age 3 November 2016 VEPTR Implantation for Children with congenital scoliosis under Age 3 Dr. J. Berger-Groch, Dr. OD. Jungesblut, Dr. C. Ridderbusch, Prof. Dr. R. Stücker

is a rare condition (1 in 10.000 birth) Congenital scoliosis is a rare condition (1 in 10.000 birth) → Therefore, it is difficult to gather a large study group. is often accompanied by comorbidities (like lung-, kidney- or heart diseases) is caused by hemi-vertebra, partial vertebral or rib fusions (bony bar), rib aplasia and mixed deformities → can have serious consequences for lung development due to thoracic deformation

Conservative (braces, casting) Surgical treatments: The alveolar-capillary proliferation reaches its peak before 2nd year of age and ends at the age of 8 years. This is why an early intervention is needed to avoid a thoracic insufficiency syndrome. Options: Conservative (braces, casting) Surgical treatments: growing rods growth guidance systems compression devices on convexity Cunin V. Early-onset scoliosis: current treatment. Orthop Traumatol Surg Res. 2015 Feb;101(1 Suppl):109-118.

VEPTR (vertical expandable prosthetic titanium rib) These are expandable devices with anchor points at ribs, pelvis or spine VEPTR can be used in children from 6 month to maturity. After the implantation a semi-annual distraction of the device is usually performed. → This poses challenges to surgeons and patients.

Study design Patients Retrospective single center study Outcome evaluation of children under age 3 with congenital scoliosis after implantation of VEPTR Follow-up 53.5±27.4 months Patients 14 children (7♀,7♂) Sept. 2007 to Dec. 2015 mean age at initial diagnosis 23,1±10,9 months Evaluation of: Comorbidities Complications thoracic height, SAL, AVR kyphosis, lordosis, Cobb angle BMI ASA-score, haemoglobin

The majority of children suffered from different comorbidities Results I: Comorbidities The majority of children suffered from different comorbidities

Verschiedene Folienlayouts Results II: Complications The average number of surgical interventions per patient was 8.3±3.9 (total 116 operations). Beside the planned surgeries all 6 months only 2 additional unplanned operations (1.72%) were necessary one because of an early wound infection one because of a skin slough. Deep infections with a need for implant removal were not seen. Perioperative issues:

Results III: Radiographic A Cobb angle improved from 56.2±12 to 36.2±20 after 3 years f/u Thoracic spine height improved from 10.8cm±1.5 to 12.8cm±2.0 after 3 years f/u

Results III: Radiographic B SAL (space available for lung) improved from 78.2%±15.2 to 86.9%±10.5 at 3 years f/u

Results IV: BMI Although the absolute body height increased the body mass index decreased from 17.4±3.6 to 14.9±1.7 after 3 years f/u, this is visualized with the corresponding percentiles.

Conclusions VEPTR is an effective method to treat congenital scoliosis in young children with an acceptable complication rate. However, follow-up studies until maturity are needed to assess final outcome of treatment.

Thank you! The Children‘s Hospital Hamburg-Altona Bleickenallee 38 Dr. Josephine Berger-Groch Prof. Dr. Ralf Stücker Telefon: +49 (040) 88 908-382 Telefax: +49 (0 040) 88 908-386 j.berger@uke.de Ralf.stücker@kinderkrankenhaus.net www.kinderkrankenhaus.net Universitätsklinikum Hamburg-Eppendorf