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Legacy Spinal Technologies
VEPTR
A historical and evidence-based overview of the VEPTR device for thoracic insufficiency syndrome and complex early-onset chest and spine deformity — a technique whose use has substantially declined as magnetic growing rods and other methods have taken over. I do not use VEPTR; this page explains what it was and why its role has faded.
The VEPTR, or Vertical Expandable Prosthetic Titanium Rib, was a device designed for some of the most complex problems in children's spine and chest surgery: thoracic insufficiency syndrome, in which the chest is too small or too deformed to allow the lungs to grow and work properly, often because of missing, fused, or absent ribs alongside scoliosis. Rather than acting only on the spine, the VEPTR was attached to the ribs — and sometimes the spine or pelvis — and could be expanded to help the chest and spine grow. I want to be candid: I do not use VEPTR, and, just as importantly, its use has substantially declined in recent years, largely superseded by magnetic growing rods and other techniques. This page explains what it was, the problem it addressed, and why it is now used far less than it once was.
For information only — not medical advice. The content on this page is patient education to help you understand a condition or treatment. It is not a substitute for personalised assessment by a qualified clinician. Always consult your doctor or specialist about your own symptoms, diagnosis, and treatment decisions.
The problem VEPTR was designed to solve
Most scoliosis surgery concerns the spine, but in some young children the fundamental problem is the chest itself — a small, stiff, or malformed thorax that cannot expand enough for the lungs to develop. This is thoracic insufficiency syndrome, and it can occur with congenital scoliosis, fused or absent ribs, or certain syndromic conditions. The VEPTR was developed specifically for this, with the goal of expanding and supporting the chest wall — an "expansion thoracoplasty" — to give the lungs room to grow, while also helping to control the associated spinal deformity. It was a genuinely different tool for a genuinely different and difficult problem, and for children with severe chest-wall deformity it addressed something that spine-only surgery could not.
What the evidence showed — benefits and a heavy complication burden
The published experience with VEPTR, mostly case series and multicentre cohorts, showed that it could control deformity and support chest and spinal growth in these very complex children. But the same literature is clear about a heavy burden of complications and repeated procedures, which is characteristic of growth-sparing surgery in general and was pronounced with VEPTR: device migration, infection, skin problems over the hardware, and the need for repeated expansions and revisions. Some studies also questioned how much the device actually improved lung function, with at least one notable paper asking whether VEPTR truly reduced children's need for respiratory support. So the honest picture is of a device that could help with an otherwise intractable problem, but at the cost of frequent complications and reoperations, and with real uncertainty about its respiratory benefit.
Why its use has declined
The most important thing for families to understand is that VEPTR is no longer a mainstream technique — its use has fallen considerably. Broad reviews of early-onset scoliosis practice and trends describe a clear shift away from VEPTR toward magnetically controlled growing rods and other growth-friendly systems, which for many children offer control of the deformity with fewer of the operations and complications associated with rib-based devices. VEPTR retains a possible niche in the most extreme chest-wall problems, where nothing else will do, but for the great majority of early-onset scoliosis it has been overtaken. It is fair to say that few surgeons use it routinely now.
Why I do not use this, and how I see it
I do not use VEPTR. It belongs to a highly specialised area of paediatric spine and chest surgery, practised by a small number of units, and its role has narrowed as the field has moved on. My honest reading is that VEPTR was an important and creative solution to thoracic insufficiency syndrome, but one with a high complication burden and uncertain respiratory benefit, now largely replaced by magnetic growing rods for most indications. Any child with a complex early-onset chest or spine deformity should be assessed by a specialist early-onset scoliosis unit that can weigh all the current options.
This page is for general education only and is not a substitute for personal medical advice. VEPTR is a highly specialised technique that I do not perform and whose use has declined. Children with complex early-onset chest or spine deformity should be assessed by a specialist early-onset scoliosis unit.
Evidence & further reading
- —Hell AK, et al. J Pediatr Orthop B. 2005. VEPTR for thoracic insufficiency syndrome with congenital and neuromuscular scoliosis. PMID 15931035
- —Campbell RM Jr, et al. Spine. 2007. VEPTR opening-wedge thoracostomy in congenital thoracic scoliosis with TIS. PMID 17873807
- —Akbarnia BA, et al. Spine. 2010. Complications of growth-sparing surgery in EOS — high complication rates. PMID 21102293
- —Flynn JM, et al. J Pediatr Orthop. 2013. VEPTR for nonsyndromic congenital scoliosis, multicentre mid-term follow-up. PMID 23812154
- —Abol Oyoun N, et al. Spine J. 2014. Bilateral rib-to-pelvis VEPTR for neuromuscular scoliosis. PMID 24161365
- —Dede O, et al. J Bone Joint Surg Am. 2014. Pulmonary and radiographic outcomes of VEPTR in EOS. PMID 25100777
- —Balioglu MB, et al. J Craniovertebr Junction Spine. 2015. Effect of VEPTR on spinal growth in congenital scoliosis. PMID 26692699
- —Nossov SB, et al. J Pediatr Orthop. 2019. "VEPTR: Are we reducing respiratory assistance requirements?" — questions pulmonary benefit. PMID 28399050
- —Ramírez N, et al. Acta Ortop Mex. 2020. Review of thoracic insufficiency syndrome. PMID 33535285
- —Ashebo L, et al. Curr Rev Musculoskelet Med. 2023. Update on EOS diagnosis/management — shift toward magnetic growing rods. PMID 37615932
- —Wijdicks SPJ, et al. Spine J. 2019. Systematic review comparing growth among growth-friendly systems. PMID 30290228
- —Kim G, et al. J Neurosurg Pediatr. 2022. Systematic review/meta-analysis comparing surgical interventions for EOS. PMID 36152334
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