The Efficacy of Rib-based Distraction With VEPTR in the Treatment of Early-Onset Scoliosis in Patients With Arthrogryposis
BACKGROUND:Although arthrogryposis multiplex congenital (AMC) is a rare condition, rapidly progressive scoliosis is common in children with AMC. Only a limited number of studies characterize the nature of these curves, and even fewer describe surgical outcomes. To determine efficacy or rib-based dis...
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creator | Astur, Nelson Flynn, John M Ramirez, Norman Glotzbecker, Michael van Bosse, Harold J Hoashi, Jane S d’Amato, Charles R Kelly, Derek M Warner, William C Sawyer, Jeffrey R |
description | BACKGROUND:Although arthrogryposis multiplex congenital (AMC) is a rare condition, rapidly progressive scoliosis is common in children with AMC. Only a limited number of studies characterize the nature of these curves, and even fewer describe surgical outcomes. To determine efficacy or rib-based distraction in these patients, we reviewed the outcomes of the use of the Vertical Expandable Prosthetic Titanium Rib (VEPTR) device in what we believe is the first study to report this.
METHODS:Search of the Chest Wall Spinal Deformity Study Group database identified 10 children with AMC and early-onset scoliosis who were treated with the VEPTR device at 6 different pediatric health centers. The 7 female and 3 male patients had their initial surgery at an average age of 5 years. Mean follow-up was 4.2 years.
RESULTS:The most common curve was from T5 to L2. After initial VEPTR insertion, the scoliosis decreased from a mean of 67 to 43 degrees (37% correction) and kyphosis from 65 to 48 degrees (29% correction). The mean proximal junctional kyphosis after initial insertion was 33 degrees. At final follow-up, scoliosis and kyphosis were 55 degrees (17% correction) and 62 degrees (8% correction), respectively. Spinal growth during the treatment period showed a mean T1-S1 increase of 4.2 cm or approximately 1 cm/y. In the 62 procedures performed over the course of the study period, 6 complications occurred in 4 patients3 infections, 2 rib failures, and 1 implant failure. Six patients had proximal junctional kyphosis of ≥45 degrees at the last follow-up.
CONCLUSIONS:In children with AMC, rib-based distraction using the VEPTR is an effective treatment method for controlling scoliosis and kyphosis and maintaining thoracic growth, but proximal junctional kyphosis remains a problem. |
doi_str_mv | 10.1097/BPO.0b013e3182a00667 |
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METHODS:Search of the Chest Wall Spinal Deformity Study Group database identified 10 children with AMC and early-onset scoliosis who were treated with the VEPTR device at 6 different pediatric health centers. The 7 female and 3 male patients had their initial surgery at an average age of 5 years. Mean follow-up was 4.2 years.
RESULTS:The most common curve was from T5 to L2. After initial VEPTR insertion, the scoliosis decreased from a mean of 67 to 43 degrees (37% correction) and kyphosis from 65 to 48 degrees (29% correction). The mean proximal junctional kyphosis after initial insertion was 33 degrees. At final follow-up, scoliosis and kyphosis were 55 degrees (17% correction) and 62 degrees (8% correction), respectively. Spinal growth during the treatment period showed a mean T1-S1 increase of 4.2 cm or approximately 1 cm/y. In the 62 procedures performed over the course of the study period, 6 complications occurred in 4 patients3 infections, 2 rib failures, and 1 implant failure. Six patients had proximal junctional kyphosis of ≥45 degrees at the last follow-up.
CONCLUSIONS:In children with AMC, rib-based distraction using the VEPTR is an effective treatment method for controlling scoliosis and kyphosis and maintaining thoracic growth, but proximal junctional kyphosis remains a problem.</description><identifier>ISSN: 0271-6798</identifier><identifier>EISSN: 1539-2570</identifier><identifier>DOI: 10.1097/BPO.0b013e3182a00667</identifier><identifier>PMID: 24327164</identifier><language>eng</language><publisher>United States: by Lippincott Williams & Wilkins</publisher><subject>Age Factors ; Age of Onset ; Arthrogryposis - diagnosis ; Arthrogryposis - epidemiology ; Arthrogryposis - surgery ; Child ; Child, Preschool ; Cohort Studies ; Databases, Factual ; Female ; Follow-Up Studies ; Humans ; Male ; Osteogenesis, Distraction - instrumentation ; Osteogenesis, Distraction - methods ; Prostheses and Implants ; Prosthesis Design ; Prosthesis Implantation - methods ; Ribs - diagnostic imaging ; Ribs - surgery ; Risk Assessment ; Scoliosis - diagnostic imaging ; Scoliosis - epidemiology ; Scoliosis - surgery ; Severity of Illness Index ; Spine - growth & development ; Time Factors ; Titanium ; Tomography, X-Ray Computed - methods ; Treatment Outcome</subject><ispartof>Journal of pediatric orthopaedics, 2014-01, Vol.34 (1), p.8-13</ispartof><rights>2014 by Lippincott Williams & Wilkins</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3567-dbb99ebe17bb9be42cdf4745541b23348da8e77a560b81c681f21b2840d3c0cc3</citedby><cites>FETCH-LOGICAL-c3567-dbb99ebe17bb9be42cdf4745541b23348da8e77a560b81c681f21b2840d3c0cc3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24327164$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Astur, Nelson</creatorcontrib><creatorcontrib>Flynn, John M</creatorcontrib><creatorcontrib>Ramirez, Norman</creatorcontrib><creatorcontrib>Glotzbecker, Michael</creatorcontrib><creatorcontrib>van Bosse, Harold J</creatorcontrib><creatorcontrib>Hoashi, Jane S</creatorcontrib><creatorcontrib>d’Amato, Charles R</creatorcontrib><creatorcontrib>Kelly, Derek M</creatorcontrib><creatorcontrib>Warner, William C</creatorcontrib><creatorcontrib>Sawyer, Jeffrey R</creatorcontrib><title>The Efficacy of Rib-based Distraction With VEPTR in the Treatment of Early-Onset Scoliosis in Patients With Arthrogryposis</title><title>Journal of pediatric orthopaedics</title><addtitle>J Pediatr Orthop</addtitle><description>BACKGROUND:Although arthrogryposis multiplex congenital (AMC) is a rare condition, rapidly progressive scoliosis is common in children with AMC. Only a limited number of studies characterize the nature of these curves, and even fewer describe surgical outcomes. To determine efficacy or rib-based distraction in these patients, we reviewed the outcomes of the use of the Vertical Expandable Prosthetic Titanium Rib (VEPTR) device in what we believe is the first study to report this.
METHODS:Search of the Chest Wall Spinal Deformity Study Group database identified 10 children with AMC and early-onset scoliosis who were treated with the VEPTR device at 6 different pediatric health centers. The 7 female and 3 male patients had their initial surgery at an average age of 5 years. Mean follow-up was 4.2 years.
RESULTS:The most common curve was from T5 to L2. After initial VEPTR insertion, the scoliosis decreased from a mean of 67 to 43 degrees (37% correction) and kyphosis from 65 to 48 degrees (29% correction). The mean proximal junctional kyphosis after initial insertion was 33 degrees. At final follow-up, scoliosis and kyphosis were 55 degrees (17% correction) and 62 degrees (8% correction), respectively. Spinal growth during the treatment period showed a mean T1-S1 increase of 4.2 cm or approximately 1 cm/y. In the 62 procedures performed over the course of the study period, 6 complications occurred in 4 patients3 infections, 2 rib failures, and 1 implant failure. Six patients had proximal junctional kyphosis of ≥45 degrees at the last follow-up.
CONCLUSIONS:In children with AMC, rib-based distraction using the VEPTR is an effective treatment method for controlling scoliosis and kyphosis and maintaining thoracic growth, but proximal junctional kyphosis remains a problem.</description><subject>Age Factors</subject><subject>Age of Onset</subject><subject>Arthrogryposis - diagnosis</subject><subject>Arthrogryposis - epidemiology</subject><subject>Arthrogryposis - surgery</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Cohort Studies</subject><subject>Databases, Factual</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Male</subject><subject>Osteogenesis, Distraction - instrumentation</subject><subject>Osteogenesis, Distraction - methods</subject><subject>Prostheses and Implants</subject><subject>Prosthesis Design</subject><subject>Prosthesis Implantation - methods</subject><subject>Ribs - diagnostic imaging</subject><subject>Ribs - surgery</subject><subject>Risk Assessment</subject><subject>Scoliosis - diagnostic imaging</subject><subject>Scoliosis - epidemiology</subject><subject>Scoliosis - surgery</subject><subject>Severity of Illness Index</subject><subject>Spine - growth & development</subject><subject>Time Factors</subject><subject>Titanium</subject><subject>Tomography, X-Ray Computed - methods</subject><subject>Treatment Outcome</subject><issn>0271-6798</issn><issn>1539-2570</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kEFP2zAYhq0JNErZP5iQj1zC7NixnSNj3ZiE1Kp02zGynS-LWRoX2xXqfj2uChw4cPInvc_7WnoQ-kzJJSW1_PJ1Mb8khlAGjKpSEyKE_IAmtGJ1UVaSHKEJKSUthKzVCTqN8Z4QKhlnH9FJyVmOBJ-g_6se8KzrnNV2h32Hl84URkdo8TcXU9A2OT_iPy71-PdssVpiN-KUO6sAOq1hTPvSTIdhV8zHCAnfWT84H13ckwudXGbiYeAqpD74v2G32edn6LjTQ4RPz-8U_fo-W13fFLfzHz-vr24Lyyohi9aYugYDVObDAC9t23HJq4pTUzLGVasVSKkrQYyiVijalTlRnLTMEmvZFF0cdjfBP2whpmbtooVh0CP4bWwoF1IwRYjKKD-gNvgYA3TNJri1DruGkmZvvcnWm7fWc-38-YetWUP7WnrRnAF1AB79kCDEf8P2EULTgx5S__72E2Z-kLQ</recordid><startdate>201401</startdate><enddate>201401</enddate><creator>Astur, Nelson</creator><creator>Flynn, John M</creator><creator>Ramirez, Norman</creator><creator>Glotzbecker, Michael</creator><creator>van Bosse, Harold J</creator><creator>Hoashi, Jane S</creator><creator>d’Amato, Charles R</creator><creator>Kelly, Derek M</creator><creator>Warner, William C</creator><creator>Sawyer, Jeffrey R</creator><general>by Lippincott Williams & Wilkins</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201401</creationdate><title>The Efficacy of Rib-based Distraction With VEPTR in the Treatment of Early-Onset Scoliosis in Patients With Arthrogryposis</title><author>Astur, Nelson ; Flynn, John M ; Ramirez, Norman ; Glotzbecker, Michael ; van Bosse, Harold J ; Hoashi, Jane S ; d’Amato, Charles R ; Kelly, Derek M ; Warner, William C ; Sawyer, Jeffrey R</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3567-dbb99ebe17bb9be42cdf4745541b23348da8e77a560b81c681f21b2840d3c0cc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Age Factors</topic><topic>Age of Onset</topic><topic>Arthrogryposis - diagnosis</topic><topic>Arthrogryposis - epidemiology</topic><topic>Arthrogryposis - surgery</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Cohort Studies</topic><topic>Databases, Factual</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Male</topic><topic>Osteogenesis, Distraction - instrumentation</topic><topic>Osteogenesis, Distraction - methods</topic><topic>Prostheses and Implants</topic><topic>Prosthesis Design</topic><topic>Prosthesis Implantation - methods</topic><topic>Ribs - diagnostic imaging</topic><topic>Ribs - surgery</topic><topic>Risk Assessment</topic><topic>Scoliosis - diagnostic imaging</topic><topic>Scoliosis - epidemiology</topic><topic>Scoliosis - surgery</topic><topic>Severity of Illness Index</topic><topic>Spine - growth & development</topic><topic>Time Factors</topic><topic>Titanium</topic><topic>Tomography, X-Ray Computed - methods</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Astur, Nelson</creatorcontrib><creatorcontrib>Flynn, John M</creatorcontrib><creatorcontrib>Ramirez, Norman</creatorcontrib><creatorcontrib>Glotzbecker, Michael</creatorcontrib><creatorcontrib>van Bosse, Harold J</creatorcontrib><creatorcontrib>Hoashi, Jane S</creatorcontrib><creatorcontrib>d’Amato, Charles R</creatorcontrib><creatorcontrib>Kelly, Derek M</creatorcontrib><creatorcontrib>Warner, William C</creatorcontrib><creatorcontrib>Sawyer, Jeffrey R</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of pediatric orthopaedics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Astur, Nelson</au><au>Flynn, John M</au><au>Ramirez, Norman</au><au>Glotzbecker, Michael</au><au>van Bosse, Harold J</au><au>Hoashi, Jane S</au><au>d’Amato, Charles R</au><au>Kelly, Derek M</au><au>Warner, William C</au><au>Sawyer, Jeffrey R</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Efficacy of Rib-based Distraction With VEPTR in the Treatment of Early-Onset Scoliosis in Patients With Arthrogryposis</atitle><jtitle>Journal of pediatric orthopaedics</jtitle><addtitle>J Pediatr Orthop</addtitle><date>2014-01</date><risdate>2014</risdate><volume>34</volume><issue>1</issue><spage>8</spage><epage>13</epage><pages>8-13</pages><issn>0271-6798</issn><eissn>1539-2570</eissn><abstract>BACKGROUND:Although arthrogryposis multiplex congenital (AMC) is a rare condition, rapidly progressive scoliosis is common in children with AMC. Only a limited number of studies characterize the nature of these curves, and even fewer describe surgical outcomes. To determine efficacy or rib-based distraction in these patients, we reviewed the outcomes of the use of the Vertical Expandable Prosthetic Titanium Rib (VEPTR) device in what we believe is the first study to report this.
METHODS:Search of the Chest Wall Spinal Deformity Study Group database identified 10 children with AMC and early-onset scoliosis who were treated with the VEPTR device at 6 different pediatric health centers. The 7 female and 3 male patients had their initial surgery at an average age of 5 years. Mean follow-up was 4.2 years.
RESULTS:The most common curve was from T5 to L2. After initial VEPTR insertion, the scoliosis decreased from a mean of 67 to 43 degrees (37% correction) and kyphosis from 65 to 48 degrees (29% correction). The mean proximal junctional kyphosis after initial insertion was 33 degrees. At final follow-up, scoliosis and kyphosis were 55 degrees (17% correction) and 62 degrees (8% correction), respectively. Spinal growth during the treatment period showed a mean T1-S1 increase of 4.2 cm or approximately 1 cm/y. In the 62 procedures performed over the course of the study period, 6 complications occurred in 4 patients3 infections, 2 rib failures, and 1 implant failure. Six patients had proximal junctional kyphosis of ≥45 degrees at the last follow-up.
CONCLUSIONS:In children with AMC, rib-based distraction using the VEPTR is an effective treatment method for controlling scoliosis and kyphosis and maintaining thoracic growth, but proximal junctional kyphosis remains a problem.</abstract><cop>United States</cop><pub>by Lippincott Williams & Wilkins</pub><pmid>24327164</pmid><doi>10.1097/BPO.0b013e3182a00667</doi><tpages>6</tpages></addata></record> |
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subjects | Age Factors Age of Onset Arthrogryposis - diagnosis Arthrogryposis - epidemiology Arthrogryposis - surgery Child Child, Preschool Cohort Studies Databases, Factual Female Follow-Up Studies Humans Male Osteogenesis, Distraction - instrumentation Osteogenesis, Distraction - methods Prostheses and Implants Prosthesis Design Prosthesis Implantation - methods Ribs - diagnostic imaging Ribs - surgery Risk Assessment Scoliosis - diagnostic imaging Scoliosis - epidemiology Scoliosis - surgery Severity of Illness Index Spine - growth & development Time Factors Titanium Tomography, X-Ray Computed - methods Treatment Outcome |
title | The Efficacy of Rib-based Distraction With VEPTR in the Treatment of Early-Onset Scoliosis in Patients With Arthrogryposis |
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