Expansion Thoracoplasty for Thoracic Insufficiency Syndrome Associated with Jarcho-Levin Syndrome.

[Introduction][1] Although surgical treatment of spondylothoracic dysplasia (STD) is controversial, we have found that an expansion thoracoplasty using a Vertical Expandable Prosthetic Titanium Rib (VEPTR; DePuy Synthes) results in favorable outcomes, including 100% survivability (at an average follow-up of 6.2 years), increased thoracic spinal length, and decreased requirements for ventilation support. [Step 1: Preoperative Preparation][2] Make anteroposterior and lateral radiographs of the spine. [Step 2: Position the Patient for the Procedure][3] The patient is placed in the prone position. [Step 3: The Incision][4] A curvilinear skin incision is made, starting proximally between the spine and the medial edge of the scapula. [Step 4: The Osteotomy][5] Perform the v-osteotomy. [Step 5: Placement of the VEPTR Device][6] A number-4 VEPTR-I device is wedged in, starting laterally within the osteotomy sites, wedging the osteotomies apart, distracting the superior ribs proximally and the inferior ribs distally, lengthening the hemithorax, and stopping approximately at the posterior axillary line, when there is maximum stress on the superior and inferior ribs, to avoid fracture, and the lamina spreaders are then removed. [Step 6: Wound Closure][7] Insert drains and local anesthetic catheters and close the wound. [Step 7: Expansion and Replacement Procedures][8] Lengthen the devices with the standard VEPTR technique of limited 3-cm incisions every three to six months. [Results][9] VEPTR treatment in patients with STD is associated with increased thoracic spine height and reduced thoracic width-to-height ratio, suggesting a greater gain in height than in width. [What to Watch For][10] [Indications][11] [Contraindications][12] [Pitfalls & Challenges][13] [Introduction][1] Although surgical treatment of spondylothoracic dysplasia (STD) is controversial, we have found that an expansion thoracoplasty using a Vertical Expandable Prosthetic Titanium Rib (VEPTR; DePuy Synthes) results in favorable outcomes, including 100% survivability (at an average follow-up of 6.2 years), increased thoracic spinal length, and decreased requirements for ventilation support. [Step 1: Preoperative Preparation][2] Make anteroposterior and lateral radiographs of the spine. [Step 2: Position the Patient for the Procedure][3] The patient is placed in the prone position. [Step 3: The Incision][4] A curvilinear skin incision is made, starting proximally between the spine and the medial edge of the scapula. [Step 4: The Osteotomy][5] Perform the v-osteotomy. [Step 5: Placement of the VEPTR Device][6] A number-4 VEPTR-I device is wedged in, starting laterally within the osteotomy sites, wedging the osteotomies apart, distracting the superior ribs proximally and the inferior ribs distally, lengthening the hemithorax, and stopping approximately at the posterior axillary line, when there is maximum stress on the superior and inferior ribs, to avoid fracture, and the lamina spreaders are then removed. [Step 6: Wound Closure][7] Insert drains and local anesthetic catheters and close the wound. [Step 7: Expansion and Replacement Procedures][8] Lengthen the devices with the standard VEPTR technique of limited 3-cm incisions every three to six months. [Results][9] VEPTR treatment in patients with STD is associated with increased thoracic spine height and reduced thoracic width-to-height ratio, suggesting a greater gain in height than in width. [What to Watch For][10] [Indications][11] [Contraindications][12] [Pitfalls & Challenges][13] [1]: #sec-12 [2]: #sec-13 [3]: #sec-14 [4]: #sec-15 [5]: #sec-16 [6]: #sec-17 [7]: #sec-18 [8]: #sec-19 [9]: #sec-20 [10]: #sec-21 [11]: #sec-22 [12]: #sec-23 [13]: #sec-24