• Klane K White, Kit M Song, Nathan Frost, and Brian K Daines.
• Department of Orthopedic Surgery, Seattle Children's Hospital, 4800 Sand Point Way, W-7706, Seattle, WA 98105, USA.
• Clin. Orthop. Relat. Res. 2011 May 1;469(5):1335-41.

BackgroundThe Vertical Expandable Prosthetic Titanium Rib (VEPTR™; Synthes North America, West Chester, PA) reportedly controls spinal deformity associated with constrictive chest wall conditions.Questions/PurposesWe asked whether spine-to-spine constructs using VEPTR™ instrumentation in combination with standard spinal instrumentation could be deployed to salvage failed rib-to-spine constructs used originally in patients with constricted chest walls and to primarily treat progressive spinal deformity without chest wall abnormalities.Patients And MethodsFifty patients were treated with VEPTR™ constructs for thoracic insufficiency syndrome at our center between 2001 and 2007. Fourteen of these 50 patients had placement of a spine-to-spine construct using a VEPTR™ implant in combination with standard spinal implants and are the subject of this retrospective review. Five had prior rib-based VEPTR™ or growing implants with an average of two failures before this surgery. Radiographic variables, preceding treatment, complications, and changes in ambulatory status, were recorded. The minimum followup was 2 years (mean, 35 months; range, 2-4 years).ResultsAfter an average of five expansions in these 14 patients, positive changes were recorded for Cobb angle, T1-S1 height, sagittal balance, and space available for the lung. Complications included two rod fractures, two superficial infections, and one deep infection with rod removal.ConclusionsVEPTR™ instrumentation as a spine-to-spine growing-rod construct demonstrated ease of implantation and expansion, with complication rates similar to other reported devices. This study suggests growing constructs using VEPTR™ can be used with relatively few complications and extends the potential uses of this instrumentation system.

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