Multidisciplinary approach to expansion thoracoplasty for congenital spinal deformity: a preliminary report.
Sherwood W., Lakhoo K.
BACKGROUND: In children with congenital chest wall deformities, the vertical expandable prosthetic titanium Rib (VEPTR) has recently been developed to move the emphasis away from corrective spinal fusion, to expanding the deformed hemithorax. The aim of this paper is to demonstrate the need for paediatric surgeons in what is primarily an orthopaedic procedure. MATERIALS AND METHODS: All patients less than 5 years old who had primary congenital scoliosis with poor respiratory function and were treated by VEPTR at our institution in conjunction with the spinal orthopaedic surgeons were reviewed. RESULTS: All 6 cases required rib exposure and thoracostomy by a paediatric surgeon. One required exposure of the ribs only, 3 required an extrapleural thoracotomy and 2 required intrapleural thoracotomy with a patch repair of the rib space. None of the patients required blood transfusion and there were no early complications. All patients showed radiological improvement of their spinal and thoracic deformity as well as improvement in their respiratory function. CONCLUSION: Paediatric surgeons play an important role in the thoracic exposure required for this orthopaedic procedure. The benefit of a multidisciplinary approach is highlighted in this paper. The VEPTR implant may replace major spinal fusion surgery in this challenging group of patients.