Orthopedics and Sports Medicine

Vertical Expandable Prosthetic Titanium Rib (VEPTR)

What is a vertical expandable prosthetic titanium rib (VEPTR)?

The vertical expandable prosthetic titanium rib (VEPTR) is a curved metal rod. It is used to:

  • Make the spine and ribs stable in children with severe chest wall deformities so they can breathe better.
  • Rebuild the chest when surgeons need to remove ribs for some types of cancer surgery.

We use the titanium rib to treat children who have thoracic insufficiency syndrome (TIS). 

What is thoracic insufficiency syndrome?

In TIS, the thorax (spine, rib cage and breastbone) cannot support normal breathing. TIS may have many causes. It is often caused by problems with the way the chest and spine formed. Your child’s doctor can talk with you about the cause of your child’s TIS.

Treatment includes  and surgery. The 2 types of surgery are and placement of a titanium rib.

How does a VEPTR work?

The titanium rib helps:

  • Straighten and spread the ribs. This makes more space in your child’s chest for their lungs to expand when they breathe. It also makes more space for their lungs to grow as they get older.
  • Make the diaphragm, the main muscle used in breathing, stable. To help your child breathe better, a stable diaphragm may matter even more than the space in their chest.

What happens during VEPTR surgery?

During surgery, the doctor adjusts the VEPTR to fit your child. Then the surgeon attaches it to your child’s ribs near the spine. It doesn’t go across the body side to side (horizontally) as your child’s own ribs do. Instead, it goes up and down (vertically). This helps open space between your child’s ribs or bridge the gap where ribs were removed.

The device can expand. As your child grows, doctors may do surgery again to lengthen it. Doctors can usually do these surgeries through a small cut (incision) in your child’s back. Sometimes a child can go home the same day.

Other surgeries to treat chest wall deformities do not let the body expand as a child grows. This is why the VEPTR was developed. Results of a multicenter study showed the VEPTR was safe and effective in children with severe scoliosis and chest wall deformities.

What’s special about the experience at Seattle Children’s?

U.S. News and World Report Best Children's Hospitals badgeSeattle Children’s was the first hospital in the western United States to offer the VEPTR. We are very experienced with using these devices in many ways to solve each child’s TIS problem.

We have placed over 100 VEPTRs in children. Our orthopedic surgeons work with our general and thoracic surgeons to do the surgery. This team approach has led to 1 of the lowest complication rates for these devices in the nation.

The experts you need are here

  • We bring together a team of specialists to diagnose and treat children with chest wall deformities. If your child might need a VEPTR for TIS, their team will include experts from OrthopedicsGeneral and Thoracic Surgery and Pulmonary Medicine.
  • Conditions that cause TIS can affect more than a child’s chest, spine and ribs. That’s why we connect you and your family with any expert your child may need across Seattle Children’s. For example, we may involve Rehabilitation Medicine, Rheumatology and Pain Medicine.

Our approach to surgery increases comfort and reduces stress

  • Our new state-of-the-art operating rooms reduce stress and increase comfort for your child. The design lets you stay by your child’s side until they gently go to sleep before any spine surgery.
  • Before we recommend surgery, we look at your child as a whole person. Your child’s team will take many factors into account. These include how serious their condition is, the effects on their health and how much more they will grow. We also consider what results you can expect from treatment.
  • We have the technology and skills to use 3D imaging to guide your child’s surgery, if needed. This helps us place hardware, like a VEPTR, with precision. It also lets us see in real time the changes we make to your child’s spine and rib cage. Based on your child’s needs, we may use or .

Care from birth through young adulthood

  • Each child with TIS is different. We will make a complete treatment plan for your child’s exact needs. Our experts specialize in kids. We have the knowledge, training and skills to treat even the youngest patients.
  • Babies, children and teens are still developing. When we evaluate your child’s condition, plan their treatment and provide their care, we carefully consider their growth. We think about how growth may affect their TIS over time. We also consider how their chest, spine and ribs may affect the rest of their health.
  • If your child needs imaging that uses radiation, we use the lowest amount possible (PDF) to make the best image. We have a low-dose radiation X-ray machine, called the EOS. It makes safer full-body images. We also have the largest group of  pediatric radiologists in the Northwest.

Support for your whole family

  • We know it can be stressful to have a child with a serious condition and to find the treatment they need. Everyone at Seattle Children’s works to make your experience here as easy as we can on your child and your whole family.
  • Your child’s team does more than plan and provide care for your child. We also make sure you and your child understand your child’s condition and treatment options.
  • Care is easier for you because your child’s team includes experts from across Seattle Children’s. They work closely with each other to provide and coordinate the care your child may need.
  • Seattle Children’s supports your family with a range of resources. Our Child Life specialists, Family Resource Center and Guest Services are here to help.

Research and advances to improve care

  • In 2002, Seattle Children’s was chosen by the U.S. Food and Drug Administration (FDA) as 1 of 7 institutions in North America to test the VEPTR. We were the first in the western United States to offer the surgery and the fourth in the nation to help test the device before it was approved in 2005.
  • Since that time, our doctors have taught other doctors how to do the procedure. We have given national and international presentations about the results of using the VEPTR.

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Contact Orthopedics and Sports Medicine at 206-987-2109 for an appointment, second opinion or more information.

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