Coronal Cobb Correction with the VEPTR Device in Patients with Scoliosis and Chest Wall Abnormalities

Methods: A query was done of a database containing information on 214 patients who had been treated with the VEPTR device for scoliosis and chest wall abnormalities. Eight patients had a flail chest, 75 rib fusion, 87 hypoplastic thorax, and 44 progressive scoliosis and constricted chest wall. The VEPTR had been used in all patients to treat thoracic insufficiency syndrome; the added benefit of scoliosis correction was secondary. The average age at the time of surgery was 6 years, and the average age at follow-up was 9 years. All patients had at least 2 years of follow-up.

Summary: The mean coronal Cobb magnitude prior to surgery was 51 degrees. Postoperatively, it had been decreased to a mean of 37 degrees. At a mean follow-up of 3.5 years, the mean Cobb angle was 39 degrees. This represented a mean change from the preoperative value of -11 degrees. The percent correction observed at follow-up was 36% in the flail chest group, 21% in the rib fusion group, 8% in the hypoplastic thorax group, and 28 % in the progressive scoliosis group. In every patient, the correction obtained at the time of initial surgery was maintained at last follow-up.

Significance: The VEPTR device is able to improve coronal Cobb measurements at the time of initial insertion. This correction was maintained in all four groups at the time of last follow-up. These data are important, as the use of the VEPTR as a growing spine device increases. The overall mean improvements in coronal Cobb magnitude do not appear to be as great as has been reported in the literature for growing rods. To confirm this finding, a prospective study will need to be done.