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U of U Physicians to Teach Doctors from Around Country New Surgery for Kids with Congenital Scoliosis

April 26, 2002 — A titanium “rib” that helps correct chest wall deformities in children with congenital scoliosis will be implanted for the first time in Utah on May 1 by University of Utah School of Medicine orthopedic surgeons.

The U medical school faculty members, along with the Texas orthopedist who pioneered the procedure, will implant the Vertical Expandable Prosthetic Titanium Rib (VEPTR) in two children, with surgeons from around the country looking on. The operations are part of the University’s role as one of seven U.S. medical centers evaluating VEPTR and teaching the operation to other surgeons.

U faculty members will explain the device and operation in a training session on Tuesday, April 30, with the two surgeries scheduled the next day at Primary Children’s Medical Center (PCMC) in Salt Lake City. The U physicians serve on the PCMC staff.

Congenital scoliosis is a spinal deformity that stunts chest-cavity growth and stops the lungs from fully developing to support normal respiration. This results in Thoracic Insufficiency Syndrome (TIS), which in some cases can be life-threatening.

“Historically, the treatment for this problem has been inadequate,” said John T. Smith, M.D., professor of orthopedics at the U medical school and one of the physicians who will teach the operation.

Until recently, surgery for congenital scoliosis was limited to spinal fusion, which prevented the deformity from getting worse with growth. The titanium rib not only helps to straighten the spine, but also allows for expansion of the chest cavity, giving the lungs room to grow.

The device, introduced by orthopedist Robert C. Campbell, M.D., of the University of Texas Health Science Center in San Antonio, is a narrow, titanium I-beam with attachments that grab onto the ribs. The beam is surgically placed in the rib cage with the attachments at the top and bottom of the ribs to help the spine grow straighter. The I-beam can be lengthened as children grow.

A pilot study conducted by Smith, Sohrab Gollogly, M.D., an orthopedic resident at the U School of Medicine, and Campbell, found that five patients nationwide who received the titanium rib experienced increased chest volumes of 40 percent to 60 percent. Smith will present the results of the study at a conference in Switzerland in May.

The U’s evaluation of the titanium rib is being conducted by Smith; John Braun, M.D., assistant professor of orthopedic surgery; John Hawkins, M.D., professor of cardiothoracic surgery; and Derek A. Uchida, M.D., associate professor in the pulmonary division of the pediatrics department.

Smith learned the procedure under Campbell in San Antonio. Along with the University of Utah, other medical centers involved in the evaluation are in Boston, Philadelphia, Pittsburgh, San Antonio, Los Angeles and Seattle. The U.S. Food and Drug Administration has not yet approved the titanium rib, but Smith expects that will happen within a year.

Spinal deformities in children are relatively rare, but that doesn’t mean a lot of kids couldn’t benefit from the titanium rib, according to Smith. “We now are evaluating 10 children from the Intermountain region who have severe deformities of the spine and chest wall and could benefit from the surgery,” he said.

Editor’s Note: A limited number of photographers and videographers can observe the surgery on Wednesday, but to do so must make arrangements in advance.