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Complications in Pediatric Spine Surgery Using the Vertical Expandable Prosthetic Titanium Rib: The French Experience

Lucas, Grégory MD*; Bollini, Gérard MD; Jouve, Jean-Luc MD; de Gauzy, Jérome Sales MD; Accadbled, Franck MD; Lascombes, Pierre MD§; Journeau, Pierre MD§; Karger, Claude MD; Mallet, Jean François MD; Neagoe, Petre MD**; Cottalorda, Jérome MD††; De Billy, Benoit MD‡‡; Langlais, Jean MD‡‡; Herbaux, Bernard MD§§; Fron, Damien MD§§; Violas, Philippe MD*

doi: 10.1097/BRS.0000000000000014
Deformity

Study Design. Multicenter retrospective study of 54 children.

Objective. To describe the complication rate of the French vertical expandable prosthetic titanium rib (VEPTR) series involving patients treated between August 2005 and January 2012.

Summary of Background Data. Congenital chest wall and spine deformities in children are complex entities. Most of the affected patients have severe scoliosis often associated with a thoracic deformity. Orthopedic treatment is generally ineffective, and surgical treatment is very challenging. These patients are good candidates for VEPTR expansion thoracoplasty. The aim of this study was to evaluate the potential complications of VEPTR surgery.

Methods. Of the 58 case files, 54 were available for analysis. The series involved 33 girls and 21 boys with a mean age of 7 years (range, 20 mo–14 yr and 2 mo) at primary VEPTR surgery. During the follow-up period, several complications occurred.

Results. Mean follow-up was 22.5 months (range, 6–64 mo). In total, 184 procedures were performed, including 56 VEPTR implantations, 98 expansions, and 30 nonscheduled procedures for different types of complications: mechanical complications (i.e., fracture, device migration), device-related and infectious complications, neurological disorders, spine statics disturbances. Altogether, there were 74 complications in 54 patients: a complication rate of 137% per patient and 40% per surgery. Comparison of the complications in this series with those reported in the literature led the authors to suggest solutions that should help decrease their incidence.

Conclusion. The complication rate is consistent with that reported in the literature. Correct determination of the levels to be instrumented, preoperative improvement of nutritional status, and better evaluation of the preoperative and postoperative respiratory function are important factors in minimizing the potential complications of a technique that is used in weak patients with complex deformities.

Level of Evidence: 4

Supplemental Digital Content is Available in the Text.This is a multicenter retrospective study of 54 children treated for severe scoliosis with vertical expandable prosthetic titanium rib (VEPTR) device. Mean follow-up was 22.5 months. One hundred eighty-four procedures were performed, including 56 VEPTR implantations, 98 expansions, and 30 nonscheduled procedures for different types of complications.

*Department of Pediatric Orthopaedic Surgery, Hôpital Sud, Rennes, France

Department of Pediatric Orthopaedic Surgery, Hôpital La Timone, Marseille, France

Department of Pediatric Orthopaedic Surgery, Hôpital Purpan Enfants, Toulouse, France

§Department of Pediatric Orthopaedic Surgery, Hôpital d'enfants, Vandoeuvre lès Nancy, France

Department of Pediatric Orthopaedic Surgery, Hôpital Hautepierre, Strasbourg, Germany

Department of Pediatric Orthopaedic Surgery, CHU de Caen, Caen, France

**Department of Pediatric Orthopaedic Surgery, Hôpital Morvan, Brest, France

††Department of Pediatric Orthopaedic Surgery, CHU de Montpellier, Montpellier, France

‡‡Department of Pediatric Orthopaedic Surgery, CHU de Besançon, Besançon, France; and

§§Department of Pediatric Orthopaedic Surgery, CHU de Lille, Lille, France.

Address correspondence and reprint requests to Philippe Violas, MD, Department of Pediatric Orthopaedic Surgery, Rennes University, Hôpital Sud, Boulevard de Bulgarie, 35000 Rennes, France; E-mail: philippe.violas@chu-rennes.fr

Acknowledgment date: February 19, 2013. First revision date: May 7, 2013. Second revision date: June 25, 2013. Third revision date: August 1, 2013. Acceptance date: August 7, 2013.

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

No funds were received in support of this work.

Relevant financial activities outside the submitted work: consulting fee or honorarium, support for travel, consultancy, and payment for lectures.

© 2013 by Lippincott Williams & Wilkins