Operative management of congenital early-onset scoliosis using the vertical expandable prosthetic titanium rib (VEPTR): a case series

To analyze surgical challenges and outcomes in patients who completed the whole journey of vertical expandable prosthetic titanium rib (VEPTR) treatment for congenital early-onset scoliosis (C-EOS), given the limited evidence available on VEPTR graduates. A retrospective review was conducted on nine consecutive patients with C-EOS and thoracic hypoplasia treated at a single tertiary care center, with assessment of clinical and radiological outcomes. At mean duration of 7.4 (range 4.3-10.5) years of VEPTR treatment, the mean coronal deformity angle measured 65° preoperatively, 50° postoperatively, and 58° at final follow-up. Mean T1-S1 length (pre-op 252 mm, final follow-up 333 mm) and T1-T12 length (preop 128 mm, final follow-up 196 mm) improved by 32% at final follow-up. Mean space available for lung was 86% (range 79%-93%) preoperatively, increasing to 90% (range 85%-95%) postoperatively and 97% (range 87%-107%) at final follow-up. Nine children had a cumulative 17 (188%) complications comprising wound problems, infection, and device migration or prominence. In five patients who underwent definitive fusion, mean coronal deformity angle and T1-S1 length improved by 17% and 11%, respectively. VEPTR is valuable in managing EOS, particularly in patients with thoracic insufficiency syndrome. However, the need for multiple surgeries, limited correction potential, and risk of partial loss of correction make it less suitable for other cases.