Skip to main content

Advertisement

SpringerLink
Log in

Vertical expandable prosthetic titanium rib (VEPTR): a review of indications, normal radiographic appearance and complications

  • Pictorial Essay
  • Published:
Pediatric Radiology Aims and scope Submit manuscript

Abstract

Vertical expandable prosthetic titanium rib (VEPTR) is increasingly used in the treatment of thoracic insufficiency, idiopathic and neuromuscular scoliosis and chest wall defects in children. In contrast to spinal fusion surgery, the VEPTR allows for growth while stabilizing the deformity. We illustrate the common indications and normal radiographic appearance of the three common configurations of VEPTR (cradle-to-cradle assembly, cradle with lumbar extension assembly, cradle-to-ala hook assembly). There is a relatively high rate of reported complications with VEPTR in the literature. We discuss the potential complications of VEPTR, including infection, rib fracture, dislodged hardware and neurological injury, with an emphasis on imaging diagnosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14
Fig. 15
Fig. 16
Fig. 17
Fig. 18

Similar content being viewed by others

References

  1. Ramirez N, Flynn JM, Emans JB et al (2010) Vertical expandable prosthetic titanium rib as treatment of thoracic insufficiency syndrome in spondylocostal dysplasia. J Pediatr Orthop 30:521–526

    Article  PubMed  Google Scholar 

  2. Waldhausen JH, Redding GJ, Song KM (2007) Vertical expandable prosthetic titanium rib for thoracic insufficiency syndrome: a new method to treat an old problem. J Pediatr Surg 42:76–80

    Article  PubMed  Google Scholar 

  3. Lacher M, Dietz HG (2011) VEPTR (Vertical Expandible Prosthetic Titanium Rib) treatment for Jeune syndrome. Eur J Pediatr Surg 21:138–139

    Article  CAS  PubMed  Google Scholar 

  4. Ramirez N, Flynn JM, Serrano JA et al (2009) The Vertical Expandable Prosthetic Titanium Rib in the treatment of spinal deformity due to progressive early onset scoliosis. J Pediatr Orthop B 18:197–203

    Article  PubMed  Google Scholar 

  5. Coonar AS, Wihlm JM, Wells FC et al (2011) Intermediate outcome and dynamic computerised tomography after chest wall reconstruction with the STRATOS titanium rib bridge system: video demonstration of preserved bucket-handle rib motion. Interact Cardiovasc Thorac Surg 12:80–81

    Article  PubMed  Google Scholar 

  6. Pompili C, Brunelli A, Xiume F et al (2010) Chest wall reconstruction with a titanium rib bridge for post-traumatic parietal hernia. Eur J Cardiothorac Surg 37:737

    Article  PubMed  Google Scholar 

  7. Thurlbeck WM (1982) Postnatal human lung growth. Thorax 37:564–571

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  8. Smith JR, Samdani AF, Pahys J et al (2009) The role of bracing, casting, and vertical expandable prosthetic titanium rib for the treatment of infantile idiopathic scoliosis: a single-institution experience with 31 consecutive patients. Clinical article. J Neurosurg Spine 11:3–8

    Article  PubMed  Google Scholar 

  9. Emans JB, Caubet JF, Ordonez CL et al (2005) The treatment of spine and chest wall deformities with fused ribs by expansion thoracostomy and insertion of vertical expandable prosthetic titanium rib: growth of thoracic spine and improvement of lung volumes. Spine 30:S58–68

    Article  PubMed  Google Scholar 

  10. Samdani AF, Ranade A, Dolch HJ et al (2009) Bilateral use of the vertical expandable prosthetic titanium rib attached to the pelvis: a novel treatment for scoliosis in the growing spine. J Neurosurg Spine 10:287–292

    Article  PubMed  Google Scholar 

  11. Schulz JF, Smith J, Cahill PJ et al (2010) The role of the vertical expandable titanium rib in the treatment of infantile idiopathic scoliosis: early results from a single institution. J Pediatr Orthop 30:659–663

    Article  PubMed  Google Scholar 

  12. Campbell RM Jr, Smith MD, Mayes TC et al (2004) The effect of opening wedge thoracostomy on thoracic insufficiency syndrome associated with fused ribs and congenital scoliosis. J Bone Joint Surg Am 86-A:1659–1674

    PubMed  Google Scholar 

  13. Khorsand D, Song KM, Swanson J et al (2013) Iatrogenic radiation exposure to patients with early onset spine and chest wall deformities. Spine 38:E1108–1114

    Article  PubMed  Google Scholar 

  14. Campbell RM Jr, Smith MD (2007) Thoracic insufficiency syndrome and exotic scoliosis. J Bone Joint Surg Am 89:108–122

    Article  PubMed  Google Scholar 

  15. Akbarnia BA, Emans JB (2010) Complications of growth-sparing surgery in early onset scoliosis. Spine 35:2193–2204

    Article  PubMed  Google Scholar 

  16. Sankar WN, Acevedo DC, Skaggs DL (2010) Comparison of complications among growing spinal implants. Spine 35:2091–2096

    PubMed  Google Scholar 

  17. Latalski M, Fatyga M, Gregosiewicz A (2011) Problems and complications in VEPTR-based treatment. Orthop Traumatol Rehabil 13:449–455

    Article  Google Scholar 

  18. Nassr A, Larson AN, Crane B et al (2009) Iatrogenic thoracic outlet syndrome secondary to vertical expandable prosthetic titanium rib expansion thoracoplasty: pathogenesis and strategies for prevention/treatment. J Pediatr Orthop 29:31–34

    Article  PubMed  Google Scholar 

  19. Skaggs DL, Choi PD, Rice C et al (2009) Efficacy of intraoperative neurologic monitoring in surgery involving a vertical expandable prosthetic titanium rib for early-onset spinal deformity. J Bone Joint Surg Am 91:1657–1663

    Article  PubMed  Google Scholar 

  20. Shah SC, Birknes JK, Sagoo S et al (2009) Vertical expandable prosthetic titanium rib (VEPTR): indications, technique, and management review. Surg Technol Int 18:223–229

    PubMed  Google Scholar 

Download references

Conflicts of interest

None

Author information

Authors and Affiliations

  1. Department of Radiology, Seattle Children’s Hospital, University of Washington School of Medicine, 4800 Sand Point Way NE, Seattle, WA, 98105, USA

    Shawn E. Parnell, Eric L. Effmann, Jonathon O. Swanson & Grace S. Phillips

  2. Department of Orthopedics, Shriners Hospitals for Children–Los Angeles, Los Angeles, CA, USA

    Kit Song

  3. Department of Orthopedics, Seattle Children’s Hospital, Seattle, WA, USA

    Viviana Bompadre

Authors
  1. Shawn E. Parnell
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eric L. Effmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kit Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jonathon O. Swanson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Viviana Bompadre
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Grace S. Phillips
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shawn E. Parnell.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Parnell, S.E., Effmann, E.L., Song, K. et al. Vertical expandable prosthetic titanium rib (VEPTR): a review of indications, normal radiographic appearance and complications. Pediatr Radiol 45, 606–616 (2015). https://doi.org/10.1007/s00247-014-3128-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00247-014-3128-4

Keywords

Search

Navigation