Vertical Expandable Prosthetic Titanium Rib (VEPTR)

What is a VEPTR?

The Vertical Expandable Prosthetic Titanium Rib (VEPTR) is a curved metal rod designed for many uses:

• To stabilize the spine and ribs in children with severe chest wall deformities so they can breathe better
• To treat scoliosis, a sideways curve in the spine
• To reconstruct the chest when several ribs have to be removed for some types of cancer surgery

We use the titanium rib to treat children who have a group of conditions called thoracic insufficiency syndrome (TIS).

What is thoracic insufficiency syndrome?

In TIS, the thorax (spine, rib cage and breastbone) cannot support normal breathing. TIS may have many causes. It is often caused by problems with the way the chest and spine developed. Your doctor can talk with you about the cause of your child’s TIS.

Treatment options are limited and include supportive pulmonary care and surgery. The two types of surgery are thoracoplastyand placement of a titanium rib.

How does a VEPTR work?

The titanium rib helps:

• Straighten your child’s spine and separate the ribs. This makes more space in the chest for the lungs to expand when your child breathes and for the lungs to grow as your child gets older.
• Stabilize the diaphragm, the main muscle used in breathing. To help your child breathe better, a stable diaphragm may be even more important than more space in the chest.

During surgery, the doctor adjusts the VEPTR device to fit your child and then attaches it to your child’s ribs near the spine. Instead of lying across the body horizontally (side to side) as your child’s own ribs do, the device attaches to your child’s ribs vertically (up and down). This helps open up space between your child’s ribs or bridge the gap where ribs might have been removed.

The device is expandable, and as your child grows doctors may operate again to lengthen it. Doctors can usually do these surgeries through a small incision in your child’s back. Sometimes they can do this as an outpatient (day) surgery.

In some children we can use a newer version of the VEPTR that can be expanded with magnets so the child does not need another surgery to expand it. Your child’s doctor can talk with you about which type of VEPTR is best for your child.

What is your experience with the VEPTR?

Our chest wall deformity team and our spine team bring together specialists in orthopedic surgery, general and thoracic surgery and pulmonary medicine to diagnose and treat children with chest wall deformities and scoliosis.

In 2002, Seattle Children’s was chosen by the U.S. Food and Drug Administration (FDA) as 1 of 7 institutions in North America to test the VEPTR. We were the first institution in the western United States to offer the surgery, and the fourth in the nation to help test the device.

Since then, we have placed 96 VEPTR devices in children with TIS problems. We are very experienced with using these devices in many ways to help solve each child’s TIS problem. Our orthopedic surgery and general and thoracic surgery teams work together during surgery to place VEPTRs. Our collaborative approach has led to one of the lowest complication rates of using these devices in the nation.

Results of a multicenter study testing the VEPTR showed that it was safe and effective in helping children with severe scoliosis and chest wall deformities. In 2005, the FDA changed the status of the device so that it is no longer considered “investigational.”

Since that time, our doctors have been teaching other doctors how to do the procedure and have given national and international presentations about the results of using the VEPTR.

What other treatments do you use to help children with TIS and chest wall deformities?

At Seattle Children’s, our chest wall deformity team and spine team have many years of experience in diagnosing and treating children with TIS, chest wall deformities and severe scoliosis at a very early age.

Each child with TIS is different. Your child will be seen by our specialists in orthopedic surgery, general and thoracic surgery and pulmonary medicine, and we will create a comprehensive treatment plan for your child’s exact needs.

Until the VEPTR was available, there was no consistently effective way of treating TIS and related conditions. Other surgeries to treat chest wall deformities do not allow for expansion to keep up with a child’s growth. This was the main problem with most other surgeries, and it was the reason the VEPTR was developed.

For large scoliosis deformities in very young children, we can use nonsurgical treatments such as casts and braces, but often these treatments do not prevent scoliosis from getting worse. We also offer treatment with “growing rod” systems to stabilize large spinal curves in young children, and are very experienced with these treatments.