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Congenital Scoliosis
Surgical Options
Expansion Thoracoplasty and VEPTR Treatment
Congenital scoliosis in the thoracic spine often includes malformation of the ribs that may limit the growth of the lungs and chest cavity. If the chest wall limitations (fused ribs, rib indentations, or vertebral anomalies) limit the child’s ability to breathe normally, it is called
thoracic insufficiency syndrome. A technique called "
expansion thoracoplasty" was developed to cut the fused ribs in order to expand the space for the lungs. This, in combination with the vertical expandable prosthetic titanium rib (VEPTR or "titanium rib") device, have been approved by the FDA to treat the combined thoracic deformity (spine/rib cage). The procedure enlarges the constricted chest and straightens the spine indirectly without a spine fusion
(see Figure 1). VEPTR devices are placed under the scapula (shoulder blade), or near the center. The device(s) is/are attached to the ribs near the neck and continue down to either the spine, or the ribs near the waist. This helps to stabilize the surgically expanded chest wall constriction (expansion thoracoplasty). To accommodate later growth, the devices are expanded twice a year in outpatient surgery through small incisions. Your child's spine surgeon can advise whether your child's condition is appropriate for VEPTR treatment.
Figure 1.
A) A front X-ray of spine showing multiple mid-thoracic hemi-vertebrae that produced a severe scoliosis.
B) VEPTR surgery has used 2 rods to stabilize the severe congenital scoliosis.
