1. 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

2. is a rare condition (1 in 10.000 birth)
Congenital scoliosis
is a rare condition (1 in 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

3. 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 Feb;101(1 Suppl):

4. 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.

5. 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 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

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

7. 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:

8. 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

9. 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

10. 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.

11. 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.

12. Thank you! The Children‘s Hospital Hamburg-Altona Bleickenallee 38
Dr. Josephine Berger-Groch
Prof. Dr. Ralf Stücker
Telefon: +49 (040)
Telefax: +49 (0 040)
Universitätsklinikum Hamburg-Eppendorf