VEPTR Overview

VEPTR™ is an acronym for Vertical Expandable Prosthetic Titanium Rib and is often referred to as a titanium rib. It is a curved metal medical implant used on the back of the chest wall in children. 

Unlike a child’s natural horizontal ribs, the VEPTR™ is positioned vertically, (parallel to the spine) beneath the child’s skin and muscle. It helps the spine to become straighter and is periodically lengthened to accommodate the child’s growth. It can also help keep a child’s natural ribs separated to allow room for the underlying lungs to more fully expand and grow. 

Often, more than one device is used on one or both sides of the back. There are several variations of the device that attach at different places on the back depending on the anatomy of the child.

The device is attached to either:

1) healthy ribs above and below, called conventional
2) ribs above and spine below, called a hybrid
3) ribs above and the iliac crest (hip bone) below, called rib to pelvis

Patients Who May Benefit From VEPTR

• those who have decreases in the size of the rib cage in relation to the rest of the body. Often, these patients will have two or more ribs that have grown together (fused ribs), absent ribs or a misshapen chest wall.
• those with curvatures of their spines. The VEPTR™ can be used as an internal brace to impart some correction to the spine, prevent the curvature from worsening, and yet allow the spine to continue to grow. This is a treatment that avoids fusing the spine which would then halt any further growth.

We have placed titanium ribs in children from ages 21 months to 12 years old.

What to Expect in the Hospital

Following the initial implant surgery, your child will be admitted overnight to the pediatric intensive care unit (PICU) then transferred to the inpatient surgical unit to continue recovery. Post-operative care in the PICU is supervised by physicians who are board certified in pediatric critical care. Staff physicians, nurse practitioners, nurses and rehabilitative therapists work as a team in caring for your child.

Most children are out of bed and starting to eat within 24-36 hours after surgery. Pain is controlled initially by IV and then by oral pain medications. Generally, hospital discharge occurs within five to seven days of the surgery.

Most children return to school approximately two weeks after hospital discharge.

After the Procedure

An outpatient visit to check surgical incisions is usually scheduled two weeks after discharge, either at our hospital or with your local orthopaedic or primary care provider. 

Lengthening of the VEPTR™ device(s) are routinely scheduled approximately every six months depending on the child's growth rate, and at later intervals if nearing skeletal maturity. We examine your child and take x-rays before each lengthening procedure to make sure the devices are still properly attached before lengthening.   

Most children return to school within a few days of the lengthening procedure.

Restrictions
There are a few restrictions, including no playing on monkey bars, tumbling, gymnastics, repetitive sit-ups, toe touches or full-contact sports. We advise no gym class or sports until physicians see how secure the devices stay attached to the affected bones, usually until the first routine device lengthening.

It is also important to protect the delicate skin and soft tissues over each device from being rubbed, scraped or sunburned.

Our Experience with the VEPTR Device

The newest device is called VEPTR II ™.  It is more versatile, less prominent and is interchangeable with the original device. Shriners Hospitals for Children – Philadelphia was the first hospital in the country to implant this new and improved titanium rib. The original VEPTR™ has been one of the many treatment options used at the hospital since May 2001. Our hospital has performed more than 350 VEPTR™- related procedures and has a support network of parents and children who are willing to share their experiences with others.