What is a Vertical Expandable Prosthetic Titanium Rib (VEPTR)?

The Vertical Expandable Prosthetic Titanium Rib (VEPTR) is the only FDA-approved device to treat thoracic insufficiency syndrome (TIS) in children. This is a congenital condition (present from birth) in which severe deformities of the chest, spine, and ribs inhibit normal lung growth, development, and the ability to breathe. The VEPTR is a curved metal rod surgically attached to the patient’s ribs, spine, or pelvis using hooks on both ends of the device. The purpose of VEPTR is to straighten the child’s spine so their lungs can grow and expand as they grow. The VEPTR can be expanded or contracted by the child’s doctor as the child grows.

The purpose of VEPTR is to:

• Allow for more normal growth patterns
• Decrease deformities of the thorax
• Decrease the need for supplemental oxygen
• Expand the volume of the lungs
• Improve the capability to perform physical activities
• Better psychosocial health

Dr. Melvin Smith, a pediatric general surgeon, and Dr. Robert M. Campbell Jr. implanted the first titanium rib into a child in Texas in 1989. Over the years, the procedure has been refined and modified, and in 2004, the U.S. Food and Drug Administration (FDA) approved VEPTR as a medical device under the Humanitarian Device Exemption Program. These are devices intended to treat rare diseases or conditions.

What Is Thoracic Insufficiency Syndrome?

Children with TIS cannot breathe normally because of thorax (spine, ribcage, and breastbone) abnormalities caused by problems in how the chest and spine developed. Treatment options for this condition are limited. The placement of a titanium rib can help a child with TIS breathe more comfortably and it allows for more normal growth of the thorax. Most children have the operation before they turn 5 years old.

What to Expect During VEPTR Surgery

During the VEPTR operation, a pediatric orthopedic surgeon attaches and adjusts the VEPTR device vertically to the child’s ribs near their spine. Sometimes more than one device is needed to create space in the chest for the lungs to develop properly.

What to Expect After VEPTR Surgery

Your child will continue to heal upon discharge from the hospital. A follow-up visit with their pediatric orthopedic surgeon will be necessary to check the incision sites.

VEPTR adjustment surgery will be required as your child grows and is typically done every 6 to 9 months until your child is fully grown and reaches skeletal maturity between the ages of 10 and 16. The surgery is necessary to expand the VEPTR device during periods of rapid growth. VEPTR may be combined with other surgical treatments, such as MAGEC or other growing rods to ensure your child continues to develop on target.

What to Expect After VEPTR Surgery

Generally, long-term outcomes after VEPTR surgery are good. Once a child reaches skeletal maturity, the care team may recommend spinal fusion surgery so the spine and chest corrections will be permanent. Some children keep the VEPTR device indefinitely, particularly if they have missing or fused ribs.