Orthopaedic Surgery Resident Cedars Sinai Medical Center
Disclosure(s):
Alfonso Ocampo, MD: No financial relationships to disclose
Introduction: The Vertical Expandable Prosthetic Titanium Rib (VEPTR) was initially developed to address thoracic insufficiency syndrome (TIS) and received FDA approval in 2004 for EOS treatment. Its ability to enhance lung function and correct spinal deformities initially generated considerable enthusiasm. However, as reports of complication rates emerged and motorized growth-sparing implants were introduced, interest in VEPTR began to decline. This trend raises questions about whether the clinical indications for VEPTR have narrowed over time. This study aims to explore the relationship between VEPTR usage and the evolution of its clinical indications from 2014 to 2023.
Methods: A retrospective review was performed using the Pediatric Spine Study Group (PSSG) registry. The study included patients diagnosed with EOS who underwent a VEPTR procedure between 2014 and 2022. Patients with prior spinal implants or fusion surgeries were excluded. We analyzed the use of VEPTR over time in relation to individual variables within the dataset, including demographics, etiology, and major curve magnitude.
Results: A total of 858 VEPTR cases were identified from 2014 to 2023. The proportion of VEPTR applications among distraction-based growing rods increased rapidly following their FDA approval in 2004, peaking in 2011 before experiencing a significant decline in 2013. Age distribution remained relatively stable over time. The majority of VEPTR implants were used in patients with congenital scoliosis (40.6%) and neuromuscular scoliosis (33.4%), followed by syndromic (14.0%) and idiopathic scoliosis (10.9%). In the initial years post-approval, congenital scoliosis was the most common indication, but by 2009, neuromuscular scoliosis had become more prevalent. Use rates for other etiologies remained constant over the study period.
Conclusion : Following rapid expansion post-FDA approval, the use of VEPTRs has significantly declined since 2013. The introduction of motorized growth-sparing implants in 2014, coupled with rising reports of complications, likely contributed to this decrease. Our findings suggest that the indications for VEPTR may be reverting to their original focus on treating TIS rather than broader applications for scoliosis.