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Updated: Jan 30, 2026
06:57
Transaxillary First Rib Resection for Treatment of the Thoracic Outlet Syndrome
Published on: September 13, 2020
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Radiographic Outcome and Complication Rate of 34 Graduates After Treatment With Vertical Expandable Prosthetic
Daniel Studer1, Philippe Büchler2, Carol C Hasler1
1Orthopaedic Department, University Children's Hospital Basel (UKBB), University of Basel, Basel.
Journal of Pediatric Orthopedics
|January 22, 2019
Summary
Graduates from vertical expandable prosthetic titanium rib (VEPTR) treatment face challenging final strategies. Avoiding final fusion may be a viable alternative, as final fusion surgery has a high complication rate.
Area of Science:
- Pediatric Orthopedics
- Spinal Surgery
- Scoliosis Management
Background:
- Managing early onset scoliosis (EOS) after growth-sparing surgery presents challenges.
- Patients treated with vertical expandable prosthetic titanium rib (VEPTR) require a definitive strategy post-treatment.
- This study evaluates outcomes for VEPTR graduates considering final fusion versus nonfusion approaches.
Purpose of the Study:
- To assess the radiographic outcomes of early onset scoliosis (EOS) patients after VEPTR treatment.
- To compare complications associated with final fusion surgery versus nonfusion strategies in VEPTR graduates.
- To inform final treatment strategies for VEPTR graduates.
Main Methods:
- Categorized final treatment into "VEPTR in situ without final fusion," "removal of VEPTR without final fusion," and "removal of VEPTR with instrumented final fusion."
- Conducted radiographic evaluations of coronal Cobb and kyphosis angles pre- and post-VEPTR, and at latest follow-up.
- Documented complications during VEPTR treatment and subsequent final fusion procedures.
Main Results:
- 34 VEPTR graduates were analyzed; 17 had final fusion, 17 followed a nonfusion strategy.
- Average coronal Cobb angle was 70° pre-VEPTR and 65° at follow-up; average kyphosis was 53° pre-VEPTR and 69° at follow-up.
- A significant 41% complication rate was observed with final fusion surgery.
Conclusions:
- VEPTR treatment and subsequent final fusion surgery are associated with high complication rates.
- Spinal and thoracic stiffness limit correction achievable with final instrumented fusion.
- Nonfusion strategies may be a suitable alternative for VEPTR graduates with adequate coronal and sagittal alignment.
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