What is a VEPTR surgery?

VEPTR stands for Vertical Expandable Prosthetic Titanium Rib.

A VEPTR procedure is a surgical procedure used to implant the VEPTR device, also known as a “titanium rib”, in order to correct abnormal spinal curvature. In some cases it may be necessary to implant more than one VEPTR device. Once implanted, the VEPTR device can be lengthened as the individual grows during a surgical procedure called a VEPTR lengthening surgery.

Which types of scoliosis is a VEPTR procedure used to treat?

A VEPTR surgery is used to treat individuals with congenital, idiopathic, and neuromuscular scoliosis.

When is a VEPTR procedure typically used?

A VEPTR procedure is typically used to treat individuals with progressive curves who are too young to undergo a spinal fusion surgery since a standard spinal fusion would inhibit further chest and lung growth. As the individual grows, the VEPTR device can be lengthened, allowing for curve correction and lung growth at the same time. In many cases the VEPTR device is used to prevent further curve progression until the individual is old enough and developed enough to undergo a spinal fusion surgery.

A VEPTR surgery is also used when individuals have either deformed, absent, or fused ribs in order to expand the chest and allow the chest and lungs to grow as the individuals grows.

What are the goals of a VEPTR surgery?

The major goal of a VEPTR surgery is to prevent, and in some cases correct, spinal curvature until the individual has sufficient chest and lung development to undergo a standard spinal fusion surgery.

What are the risks associated with a VEPTR surgery?

The risks associated with a VEPTR surgery include infection, bleeding, nerve and spinal cord injury, loosening of the device making it necessary for it to be changed or adjusted, and other risks that depend on nature and complexity of the chest and spinal deformities as well as the health of the individual.

Although these risks are rare, they should be thoroughly discussed with a surgeon before undergoing this procedure.

How long does a VEPTR surgery last?

A VEPTR surgery usually lasts between 3 and 6 hours. The length of the surgery depends on the complexity of the deformity and the health of the individual. A VEPTR lengthening procedure typically takes around one hour to complete.

Who performs VEPTR surgeries?

Most VEPTR surgeries are performed by a pediatric-fellowship-trained, board-certified orthopaedic surgeon who has specialized education in and is highly experienced in performing VEPTR surgeries.

Depending on nature and complexity of the chest and spinal deformities as well as the health of the individual, another orthopaedic surgeon, a thoracic surgeon, and/or a neurosurgeon may also help with the procedure.

How is a VEPTR surgery performed?

During a VEPTR surgery, an orthopaedic surgeon and a thoracic surgeon makes an incision (cut) to expose the spine and ribs. Most often the incisions is made along the side of the chest or the back.

Once the spine involved in the curve has been exposed, the VEPTR device is implanted. When the VEPTR device is implanted, the top end of the device is attached to the ribs and the bottom end of the VEPTR is either attached to other ribs, the spine, or the pelvis, depending on the individual’s specific needs. In some cases it may be necessary for the surgeons to implant more than one VEPTR device.

Once the VEPTR has been implanted, it is lengthened, the spinal cord monitoring team carefully monitors the individual’s spinal cord and nerve function. Once the VEPTR device is lengthened, the device helps increases the space between the attachment points and size of the chest. This places a corrective force on that part of the chest and/or spine, helping to correct the abnormal spinal curvature.

After the VEPTR device has been lengthened, the incision is closed using a special type of suture, and the incision site is covered with special bandages. The patient is then taken to the ICU to recover. Often times, following routine VEPTR lengthenings, patients do not need to go the ICU after surgery.

Most individuals will stay in the ICU overnight for monitoring and will leave the hospital between 5 and 7 days after the surgery.

Are any follow-up procedures necessary following a VEPTR surgery?

Follow-up procedures are always necessary following a VEPTR surgery because the VEPTR device is designed to be lengthened as the individual grows. Most individuals will undergo VEPTR lengthening surgeries twice a year depending on their response to the treatment. Most VEPTR lengthening surgeries last around one hour and most individuals go home the day after the VEPTR lengthening surgery.

There may also be times when portions of the device or the entire device may need to be changed or replaced, and these procedures may take longer.

Finally, because the purpose of the VEPTR device is to help correct the chest and/or spine deformity while the individual grows, most individuals will undergo a standard spinal fusion when they have completed sufficient growth.

How will I be monitored during my VEPTR procedure?

An extensive amount of monitoring occurs during VEPTR procedures to ensure the nerves of the spinal cord are not damaged. In fact, a spinal cord monitoring team must spend almost 1 hour making sure all the necessary monitoring devices are in place and working properly before the surgery can even begin. During the VEPTR surgery, the spinal cord monitoring team will monitor your brain, spinal cord, and nerve function. In addition to the spinal cord monitoring team, an anesthesia team will give you special types of medicines to help you go to sleep during the VEPTR surgery, then monitor your vital signs such as blood pressure, heart rate, breathing rate, and level of consciousness. The spinal cord monitoring team and the anesthesia team work together with the surgical team throughout the entire VEPTR procedure.

How much experience does the person who is monitoring me have?

The spinal cord monitoring team is extremely experienced in the monitoring of the brain, spinal cord, and nerve function. On average, the spinal cord monitoring team will monitor individuals during several hundred surgeries each year.

What is a ‘wake up’ test and when is it performed?

Before the development of the modern spinal cord monitoring techniques used by the spinal cord monitoring team, a ‘wake up’ test was routinely performed to determine if procedures involving the spine, such as VEPTR procedures, had affected the brain, spinal cord, and nerve function of the individual undergoing the procedure.

A wake up test is done by having the anesthesia team ‘lighten’ the level of anesthesia during the procedure. When the anesthesia is lightened, the individual undergoing the procedure will not be able to feel any pain because they will still be asleep, but individual will be able to follow simple commands, such as when told to move their feet. In this way, the wake up test allows the surgical team to directly assess the function of the spinal cord during the procedure.

Although wake up tests are rarely used anymore, if a wake up test is performed you will have no memory of it. You will be given instructions regarding the wake up test on the morning of your VEPTR procedure in case a wake up test is necessary.

Can I see the hardware that will be used in my VEPTR procedure?

Many individuals and their families like to see the hardware, including the VEPTR device (titanium ribs), that will be implanted during their VEPTR surgery.

If you would like to see examples of the types of hardware that will be used during your VEPTR procedure, your doctor can show you a sample model of the VEPTR device, including how it is mounted in the spine, before your VEPTR surgery. There is also an informational DVD on the VEPTR device which is a good source of information.

Will I be able to see or feel the hardware underneath my skin following my VEPTR procedure?

Although the hardware is placed very deeply into the back below the skin, fat, and muscles, it is common for individuals who undergo VEPTR surgeries to feel and in some cases see the location of the device under the skin. Although individuals who undergo VEPTR will be able to feel or see their hardware under their skin, it is very uncommon for the device to cause problems such as cosmetic deformity or pain.

How long will the incision (cut) be, and what should I expect in terms of scarring after my VEPTR procedure?

The length and location of the incision depends on the nature and severity of your deformity. Your doctor can show you the length of the incision and the location on your body where he expects the incision to be.

During your VEPTR procedure, your doctor will place all your stitches underneath your skin to make the incision less noticeable and eliminate the need to remove them. Most young, healthy patients will heal without any problems and their incision will eventually only appear as a long, thin scar.

Once your doctor feels your wound is healing well, you may begin using certain creams or lotions that are believed to help decrease the amount of scarring. If you decide to use any creams or lotions, you should discuss this with your doctor. Finally, once your incision heals it is important to use a high SPF sunscreen on your incision and the skin around it to help prevent your scar from becoming more noticeable, especially during first year after your VEPTR surgery.

What will be done to make my incision safe following my VEPTR procedure?

Your incision will be sewn together with a special type of suture, and, in some cases, it may also be protected with a special type of skin glue. Your doctor will also place small strips of tape and antibiotic gauze over your incision for extra strength and protection.

Will I need to return to see my doctor to have my stitches taken out after my VEPTR procedure?

Your doctor will use a special type of suture during the surgery, and, in most cases all of the stitches will be placed under the skin. Placing the stitches under the skin will help reduce potential scarring and will eliminate the need to remove stitches since they will gradually dissolve on their own.

How often will I be awakened and checked after my VEPTR procedure?

You will be awakened and checked by the anesthesiologist and your doctor as soon as your VEPTR procedure is complete.

Once you are awakened and checked by the anesthesiologist and your doctor, you will be taken to the intensive care unit (ICU) to recover. For the first night after your VEPTR surgery, your nurse may awaken you to check on you every few hours. As you continue to recover your doctor or your nurse may only check you several times each day until you are ready to go home.

When will I be able to get up and walk for the first time after my VEPTR procedure?

Because the VEPTR device is used to stabilize the spine, in most cases the spine is very stable following the surgery.

Because your spine will most likely be stable following your VEPTR surgery, you will be able to sit up almost immediately after the procedure. The first day after your VEPTR surgery, you should sit at the side of your bed and hang your feet off the side. On the second day, you should get out of bed and sit in a chair several times, and on the third day, you should begin walking around the room.

Nurses and physical therapists that have special training in the care of individuals who have had spine surgery will be in your room and help you following your VEPTR surgery. Your doctor will discuss your specific plan with you and your family after your VEPTR surgery and answer any questions you may have.

How soon will I be able to eat and drink after my VEPTR procedure?

The abdominal organs are usually less active for several days after VEPTR procedures, so you should not eat regular food for several days after your VEPTR surgery because regular food might make you feel sick and possibly vomit.

In the first few days after your surgery, your doctor and your nurses will gradually allow you to start eating normal food, starting with ice chips and sips of liquids, then moving to solid foods when your body is ready. Most patients will be able to eat regular food 4 to 5 days after their VEPTR procedure.

Most patients who undergo routine lengthening of their devices can eat immediately after surgery.

Do I need to eat a special diet and drink extra milk to help my spine heal after my VEPTR procedure?

Although no special diet or extra milk is necessary to help your spine heal after your VEPTR procedure, eating a well-balanced diet rich in calcium and protein is recommended and will help your incision and spine heal.

Individuals who have special nutritional needs will be seen by a dietary expert before and after their surgery to ensure their special dietary needs are met.

What will I be given for pain after my VEPTR procedure?

Depending on the nature and the severity of your VEPTR procedure, you will be given one of several different types of pain medicine.

To minimize your pain after your VEPTR procedure, you may be given a special device that will let you determine how much pain medicine you want and will deliver pain medicine directly into your body whenever you press it.

When you go home, your doctor will give you a prescription for pain medicine that can be taken by mouth.

How long will I need to take my pain medicine after my VEPTR procedure?

Depending on the nature and extent of your VEPTR procedure, you may take prescription pain medication for 1 to 2 weeks after surgery.

Will I need physical therapy after my VEPTR procedure?

Physical therapy is occasionally necessary following VEPTR procedures to help individuals adjust to the new position of their spine. Following your surgery, physical therapists in the hospital will help you sit up, move to a chair, and begin walking.

Most individuals will not need physical therapy after they return home.

Will I need any special type of mattress for my bed after my VEPTR procedure?

You will not need any type of special type of mattress for your bed after your VEPTR procedure. You may use whatever mattress makes you most comfortable.

When can I take a bath or shower after my VEPTR procedure?

Although individuals heal at different rates, most individuals will be able to take a bath or shower 7 to 10 days after their VEPTR procedure.

Before you get your incision wet or take a bath or shower, you should talk with your doctor to make sure your incision has healed enough for it to get wet.

When can I go back to school after my VEPTR procedure?

Although individuals heal at different rates, most individuals will be able to return to school 2 to 4 weeks after their VEPTR procedure.

How much can I do after my VEPTR procedure?

After VEPTR procedures, it is recommended that individuals walk around daily. Most patients can return to unrestricted activities within 3 months after their surgery.

Your doctor will discuss any individual recommendations he or she has with you after your VEPTR procedure, and answer any questions you may have.

Can I have children if I have a VEPTR procedure?

Because undergoing VEPTR treatment does not affect the way babies are born, individuals who have had a VEPTR surgery can give birth to babies through normal (vaginal) delivery.

If you have concerns about this, you should discuss this with your doctor or your obstetrician.