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Complications in pediatric spine surgery using the vertical expandable prosthetic titanium rib: the French experience
Grégory Lucas1, Gérard Bollini, Jean-Luc Jouve
1*Department of Pediatric Orthopaedic Surgery, Hôpital Sud, Rennes, France †Department of Pediatric Orthopaedic Surgery, Hôpital La Timone, Marseille, France ‡Department of Pediatric Orthopaedic Surgery, Hôpital Purpan Enfants, Toulouse, France §Department of Pediatric Orthopaedic Surgery, Hôpital d'enfants, Vandoeuvre lès Nancy, France ¶Department of Pediatric Orthopaedic Surgery, Hôpital Hautepierre, Strasbourg, Germany ‖Department of Pediatric Orthopaedic Surgery, CHU de Caen, Caen, France **Department of Pediatric Orthopaedic Surgery, Hôpital Morvan, Brest, France ††Department of Pediatric Orthopaedic Surgery, CHU de Montpellier, Montpellier, France ‡‡Department of Pediatric Orthopaedic Surgery, CHU de Besançon, Besançon, France; and §§Department of Pediatric Orthopaedic Surgery, CHU de Lille, Lille, France.
Study Design:
Multicenter retrospective study of 54 children.
Objective:
To describe the complication rate of the French vertical expandable prosthetic titanium rib (VEPTR) series involving patients treated between August 2005 and January 2012.
Summary Of Background Data:
Congenital chest wall and spine deformities in children are complex entities. Most of the affected patients have severe scoliosis often associated with a thoracic deformity. Orthopedic treatment is generally ineffective, and surgical treatment is very challenging. These patients are good candidates for VEPTR expansion thoracoplasty. The aim of this study was to evaluate the potential complications of VEPTR surgery.
Methods:
Of the 58 case files, 54 were available for analysis. The series involved 33 girls and 21 boys with a mean age of 7 years (range, 20 mo-14 yr and 2 mo) at primary VEPTR surgery. During the follow-up period, several complications occurred.
Results:
Mean follow-up was 22.5 months (range, 6-64 mo). In total, 184 procedures were performed, including 56 VEPTR implantations, 98 expansions, and 30 nonscheduled procedures for different types of complications: mechanical complications (i.e., fracture, device migration), device-related and infectious complications, neurological disorders, spine statics disturbances. Altogether, there were 74 complications in 54 patients: a complication rate of 137% per patient and 40% per surgery. Comparison of the complications in this series with those reported in the literature led the authors to suggest solutions that should help decrease their incidence.
Conclusion:
The complication rate is consistent with that reported in the literature. Correct determination of the levels to be instrumented, preoperative improvement of nutritional status, and better evaluation of the preoperative and postoperative respiratory function are important factors in minimizing the potential complications of a technique that is used in weak patients with complex deformities.
