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The Use of Pedicle Screws for VEPTR Fixation to the Spine

This study explores the use of reinforced pedicle screws as an alternative to hooks for VEPTR spine fixation to reduce complications. Results from eight patients with various diagnoses and complications are presented, highlighting the safety and security of pedicle screw reinforcement for distal spine fixation in VEPTR placement.

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The Use of Pedicle Screws for VEPTR Fixation to the Spine

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  1. The Use of Pedicle Screws for VEPTR Fixation to the Spine Richard E. McCarthy, M.D. Professor, Departments of Orthopaedics and Neurosurgery University of Arkansas for Medical Sciences Arkansas Children’s Hospital Frances L. McCullough, MNSc, RNP Arkansas Children’s Hospital

  2. Introduction • The original design of the VEPTR used supralaminar hooks as anchors to the spine. • One difficulty with rib to spine VEPTR has been complications related to the distal anchor hook to the spine (loss of fixation, migration) • A technique of using reinforced pedicle screws in place of the hook as fixation of the spine has been developed in an attempt to eliminate this occurrence.

  3. Methods • Charts and radiographs were reviewed on all patients who had placement of rib to spine VEPTR devices utilizing screw fixation to the spine. • The technique for the pedicle screw fixation was done with pedicle screws reinforced with fiberwire around the spinous process or lamina or with a supplemental hook above.

  4. Results • Eight patients • Diagnoses: • Congenital-4 • Neuromuscular-1 • Syndromic-2 • Cyanotic heart disease-1 • Average age at placement: 6+5 years • (range 1+6 to 17+10 years) • Average length of follow-up: 2+7 years • (range 6 weeks to 5+8 years) • Average number of lengthenings per patient: 4 • (range 0-12)

  5. Complications • Asymptomatic migration of the screw distally which was replaced at the next scheduled lengthening- 1 patient • Infection-2 patients • Upper anchor pullout- 1 patient

  6. Conclusion • Pedicle screw reinforcement offers safe and secure distal fixation at two year follow-up for rib to spine VEPTR placement.

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