Dell Children’s Medical Center of Central Texas
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Thoracic Insufficiency Program
About the Titanium Rib

Using a device made of the same material used in skyscrapers, pediatric specialists at have performed an innovative new procedure that separates and strengthens the rib cage to allow children with chest abnormalities to grow and breathe normally. Acting like braces for the teeth in reverse, the Vertical Expandable Prosthetic Titanium Rib or VEPTRTM is a metal rod curved to fit the back of the chest and spine. The rods are attached to the rib cage and have special inserts that allow them to be made longer as a child grows.

The titanium rib implant procedure was developed specifically for children with congenital rib deformities and Thoracic Insufficiency Syndrome, which causes conditions in which the thorax (chest) is unable to grow enough to support normal breathing or lung growth.

Less than 20 years ago, children who suffered from severe chest abnormalities, such as fused ribs or a very small rib cage without enough room for the lungs to grow and expand, had little recourse. With these types of problems, the lungs cannot grow at a normal rate. Lung capacity is reduced, and a child could quite literally end up suffocating to death. Now, thanks to the pioneering VEPTR procedure, these children often can look forward to a much brighter future.

"The titanium rib can literally be a life-saving procedure," explains Dr. Jay Shapiro, a pediatric orthopedic surgeon with Central Texas Pediatric Orthopedics and Scoliosis. "It is used for children who have abnormalities of the thorax, made up of the spine, ribs and breastbone; or congenital scoliosis, where the spine is crooked and gets more curved as time goes by. Children with these conditions suffer from the progressive inability of their lungs to support normal growth and development."

He adds, "In mild cases, children grow up but have reduced life spans, and in severe cases, children are already ventilator-dependent."

The VEPTR procedure allows surgeons to implant an expandable device that allows the rib cage to grow as the child matures. "In effect, it works like a car jack," says Dr. Shapiro. "The titanium rib holds the child's ribs apart and allows them to grow."

Dr. Shapiro and his surgical team, including pediatric surgeon Mark B. Smith, MD, and pediatric pulmonary specialist, William Glomb, MD, performed the first Vertical Expandable Prosthetic Titanium Rib procedure at Children's Hospital of Austin in October 2005. Only a handful of hospitals across the country offer the (VEPTR) procedure.

Robert Campbell, MD, a pediatric orthopedic surgeon and Melvin Smith, MD, a pediatric general surgeon at CHRISTUS Santa Rosa Childre's Hospital in San Antonio, developed the expandable titanium rib in 1998. The procedure is highly specialized and only a few surgeons in the country have the training and specialized skills to perform it, says Dr. Shapiro, who worked with the pioneering physicians in San Antonio.

According to Synthes Spine, the manufacturer of the titanium rib, the device is made of titanium because of its strength and ability to stay inside the body without causing a bad reaction. Titanium is a strong metal used for building skyscrapers and dental implants.

During the VEPTR surgery, physicians make a J-shaped incision and insert the device onto the child's rib cage. The device will make the rib cage longer and larger as the child grows. In essence, it works much the same way braces for the teeth do, except in reverse. The titanium rib can be lengthened, rather than tightened as the child grows.

The implants are adjusted as the child grows, generally every four to six months, and will be used until a child stops growing, according to Dr. Shapiro. Special expandable inserts allow the adjustments to be made. This helps the spine become straighter and allows the lungs to grow and fill with enough air to breathe, says Dr. Shapiro.

Children with a titanium rib implant should not play contact sports, but can do many things that they previously would not have been able to do, says Dr. Shapiro. In effect, they have their lives back.

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