Observation on the effest of vertical expandable prosthetic titanium rib technique on shoulder imbalance in children with early-onset scoliosis

English Keywords:Early-onset scoliosis  Vertical expandable prosthetic titanium rib  Shoulder balance

English Abstract:

  【Abstract】 Objectives: To investigate the effectiveness of vertical expandable prosthetic titanium rib(VEPTR) technique in treating shoulder imbalance in children with early-onset scoliosis(EOS). Methods: 8 EOS patients(6 boys and 2 girls) with obvious shoulder imbalance treated with VEPTR technique were reviewed. The average age at the index surgery was 5.0±3.4 years old(range, 3-10 years). During the regular post-operative follow-up, expansion surgery was scheduled at an interval of 6 to 12 months. They had a minimum 3-year follow-up. Measurements of primary curve magnitude, apical vertebral translation(AVT), coracoid height difference(CHD), clavicle angle(CA), clavicular tilt angle difference(CTAD) and trunk shift(TS) were performed on radiographs, and the indexes at preoperation were compared with those at postoperation, and the latest follow-up. Results: All patients had a mean follow-up of 56±8 months (range, 43-70 months). 46 surgeries in total were performed, averaging 5.8 surgeries per patient; and 38 expansion surgeries were carried out, averaging 4.8 surgeries per patient. The average interval for each expansion surgery was 10 months. From preoperation to latest follow-up, the Cobb angle of primary curves was averagely corrected from 82°±19° to 52°±18°, and AVT displayed slight improvement. The average thoracic height increased from 13.2±2.1cm to 18.3±2.4cm, and the average T1-S1 height increased from 24.3±3.7cm to 33.8±5.1cm. After the index surgery, CHD, CA and CTAD improved from 25±5mm to 19±6mm, from 9°±2° to 6°±4°, and from 13°±4° to 11°±4°, respectively. At the latest follow-up, CHD, CA and CTAD were 11±4mm, 5°±4° and 9°±4° on average, respectively. TS was found to be significantly correlated with CHD before surgery. TS was averagely corrected from 31±13mm to 16±7mm from preoperation to latest follow-up. Conclusions: In EOS patients, VEPTR technique serves as an optional fusionless strategy to prevent curve progression, to allow growth of spine, as well as to improve shoulder imbalance.