The vertical expandable prosthetic titanium rib (VEPTR) is a surgically implanted device to treat thoracic insufficiency syndrome in pediatric patients.
Thoracic insufficiency syndrome is a congenital condition where severe deformities of the chest, spine and ribs prevent normal breathing, lung growth and lung development.
The VEPTR device is a curved metal rod that is attached to a child’s ribs near the spine using hooks on both ends of the device. The VEPTR helps straighten the spine and separate ribs so the lungs can grow and expand as the child grows.
The length of the VEPTR device can be expanded or contracted as the patient grows.
Robert M. Campbell Jr., MD, designed the world’s first expandable rib in 1988. The original designs led to blue prints and official plans with Techmedica, a custom prosthesis firm in California. Dr. Campbell and Melvin Smith, MD, a pediatric general surgeon, implanted the first titanium rib into a Texas child on April 19, 1989. The Synthes Spine Co., of West Chester, PA, assumed development of the VEPTR device in 1994.
C-SPAN coverage of CHOP physician Robert M. Campbell Jr., MD, testifying about VEPTR before the U.S. Congress.
During surgery, the VEPTR device is adjusted to fit the individual child. The device is attached vertically on the patient’s ribs near the spine. In some cases, more than one VEPTR device is used to create space in the chest for the lungs to develop more fully.
The VEPTR device will be lengthened or replaced at specific times to allow for the patient’s growth and to further correct spinal or chest wall deformities.
Adjustments to the length of the VEPTR device are made during surgery through a small incision in the patient’s back.
The VEPTR device is used to treat thoracic insufficiency syndrome in pediatric patients. For more information about the causes of thoracic insufficiency syndrome and related congenital conditions, see about thoracic insufficiency syndrome.
The VEPTR should not be used for children who have completed growth or for isolated spinal deformities that can be treated with traditional orthopedic procedures that correct the deformity without threatening growth of the child's spine, chest and lungs.
Use of the VEPTR device may result in:
The U.S. Food and Drug Administration approved the vertical expandable prosthetic titanium rib (VEPTR) (H030009) under the Humanitarian Device Exemption program on Aug. 23, 2004.
A Humanitarian Use Device (HUD) is a device that is intended to benefit patients by treating or diagnosing a disease or condition that affects fewer than 4,000 people in the U.S. per year.
Because a device manufacturer's research and development costs could exceed its market returns for diseases or conditions affecting such small patient populations, the HUD regulation provides an incentive for the development of devices for use in the treatment or diagnosis of diseases affecting these populations.
Synthes Spine Co., part of Synthes, Inc., an international company based in West Chester, PA, has been producing the VEPTR since 1994. The company develops, produces and markets instruments, implants and biomaterials for the surgical fixation, correction and regeneration of the skeleton and its soft tissues.
More than 25 countries worldwide.
Long-term outcomes for patients undergoing VEPTR surgery are generally good. The expandable titanium rib allows the lungs of patients with thoracic insufficiency syndrome to grow as the child grows. When the child reaches skeletal maturity, spinal fusion surgery makes the spine correction permanent.
More experience with thoracic insufficiency syndrome and VEPTR as a treatment option are needed to provide more complete answers about long-term outcomes for children with thoracic insufficiency syndrome. Research is currently underway to help clinicians better understand what causes thoracic insufficiency syndrome, as well as what normal lung growth and capacity is, and how patients with thoracic insufficiency compare. See follow up care and our research for more details.
To schedule an appointment with the Center for Thoracic Insufficiency Syndrome at The Children’s Hospital of Philadelphia, call 215-590-3722 or contact us online.
Reviewed by: Robert M. Campbell Jr., MD
Date: January 2013