Vertical Expandable Prosthetic Titanium

Patient information

Vertical Expandable Prosthetic Titanium Rib (VEPTR) is a surgically implanted device that is used for some deformities of the spine and chest wall in children that interferes with normal growth and function.

Our spine surgeons at Children’s Mercy have been using this device since 2006. This type of implant is used only for very specific spine conditions.

The most common diagnoses for which VEPTR is used include:

• Achondroplasia
• Jarcho-Levin Syndrome
• Jeune Syndrome
• Ellis van Creveld Syndrome
• Thoracic Insufficiency Syndrome.

These conditions are typically medically complex and the child who is a potential VEPTR patient is approached in a multidisciplinary way. This means a complete evaluation by the spine surgeon, a pulmonologist (lung doctor), as well as other specialty doctors or services may be involved in that child’s ongoing care. Several kinds of testing and imaging, such as a CT scan and pulmonary tests, may also be done to determine if the child may be helped by VEPTR.

VEPTR surgery

This typically involves an inpatient stay of a few days to a week. On several occasions pre-operatively the VEPTR team will review the patient's status and discuss the nature of the surgery. There are many different techniques possible with VEPTR including rib-to-rib, rib-to-spine and rib-to-pelvis options.

There is initially a short stay in the ICU. We have found that most patients do not routinely require a long stay in the ICU; most are weaned from the ventilator overnight. Some patients, who require more extensive chest wall surgery, will also require more breathing support. This may lead to several days on a ventilator.

Post-operatively, most patients go home on oral pain medications. Follow-up x-rays are typically taken within a week of discharge and typically at a six-week follow-up. At six-to-12 monthly intervals, the VEPTR device is lengthened. Initially, the patient may stay overnight but with familiarity of the patient and family, and with approval of the surgeon, often the lengthening can be done as an outpatient.