Research and Advances
Vertical Expandable Prosthetic Titanium Rib (VEPTR)
What is a VEPTR?
The Vertical Expandable Prosthetic Titanium Rib (VEPTR) is a curved metal rod that is designed to help children with severe chest deformities breathe.
We use the titanium rib to treat children who have a group of conditions called thoracic insufficiency syndrome (TIS).
What is thoracic insufficiency syndrome (TIS)?
With thoracic insufficiency syndrome the thorax (the spine, rib cage and sternum) is unable to support normal breathing. It is often caused by problems with the way the chest and the spine develop. There are very few options for treatment. The options include supportive pulmonary care and surgery. The two types of surgery are thoracoplasty and placement of a vertical expandable prosthetic titanium rib device (VEPTR).
How does a VEPTR work?
The titanium rib helps straighten your child’s spine and separate her ribs so that she will have space in her chest for her lungs to grow and to expand with air when she breathes.
During surgery, the doctor adjusts the VEPTR device to fit your child, then attaches it to her ribs near her spine. Instead of lying across the body horizontally as your child’s own ribs do, the device attaches to her ribs vertically (up and down). In this way, it helps open up space between her ribs.
The device is expandable, and as your child grows doctors will operate again to lengthen it. Doctors can usually perform these operations through a small incision in your child’s back.
What is your experience with VEPTR?
Our chest wall deformity team was formed in 2001 to bring together specialists in orthopedic surgery, general and thoracic surgery and pulmonary medicine to help diagnose and treat children with chest wall deformities.
In 2002, Children’s was chosen as one of seven institutions in North America to test 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 implanted 30 VEPTR devices.
Results of a multi-center study testing VEPTR found that it was safe and effective in helping children with severe scoliosis and chest wall deformities. In 2005, the Food and Drug Administration 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 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 spine team has a combined 40 years of experience in diagnosing and treating children with chest wall deformities and severe scoliosis at a very early age.
Until the VEPTR was available, we did not have a consistently effective way of treating these conditions. Other surgeries to treat chest wall deformities do not allow for expansion that can keep up with a child’s growth.
For large scoliosis deformities in very young children, we can use non-surgical treatments such as casts and braces, but often these treatments do not prevent the progression of scoliosis.
We also offer treatment with “growing rod” systems to stabilize large spinal curves in young children, and have much experience with these treatments.