New Users Registration  |  Useful Links  |  FAQ  |  Site Map 
Go Search


Skip Navigation LinksHealth Xchange > News
  2013 2015   Dec 2015 | Nov 2015 | Oct 2015 | Sep 2015 | Aug 2015 | Jul 2015 | Jun 2015 | May 2015 | Apr 2015 | Mar 2015 | Feb 2015 | Jan 2015 |
  2013 2014   Dec 2014 | Nov 2014 | Oct 2014 | Sep 2014 | Aug 2014 | Jul 2014 | Jun 2014 | May 2014 | Apr 2014 | Mar 2014 | Feb 2014 | Jan 2014 |
  2013   Dec 2013 | Nov 2013 | Oct 2013 | Sep 2013 | Aug 2013 | Jul 2013 | Jun 2013 | May 2013 | Apr 2013 | Mar 2013 | Feb 2013 | Jan 2013 |
  2012   Dec 2012 | Nov 2012 | Oct 2012 | Sep 2012 | Aug 2012 | Jul 2012Jun 2012May 2012Apr 2012Mar 2012 | Feb 2012 | Jan 2012 |
  2011   Dec 2011Nov 2011Oct 2011 | Sep 2011 | Aug 2011Jul 2011Jun 2011 | May 2011 | Apr 2011 | Mar 2011 | Feb 2011 | Jan 2011 |
  2010   Dec 2010 | Nov 2010 | Oct 2010 | Sep 2010 | Aug 2010 | Jul 2010 | Jun 2010 | May 2010 | Apr 2010 | Mar 2010 | Feb 2010 | Jan 2010 |
  2009   Dec 2009 | Nov 2009 | Oct 2009 | Sep 2009 | Aug 2009 |
  Health Policy and Announcements | Diseases and Outbreaks
  Medical Research | New Treatments and Technology
  Singapore   SingHealth | Health Promotion Board | Ministry of Health | Asiaone
  International   World Health Organization | Centre for Disease Control and Prevention (US)
  News Article  

Severely deformed spine hinders toddler’s breathing

  Thursday, 12 l 05 l 2011  Source: Mind Your Body; The Straits Times   
By: Joan Chew

VEPTR-methodAn abnormally curved spine is enough of a worry, but some children born with scoliosis carry an extra burden of being unable to breathe properly too. One or two in every 100 patients with congenital scoliosis will have a spine that is so twisted that the chest and rib cage are compressed, preventing the lungs from working or growing normally.

But a new procedure introduced in KK Women’s and Children’s Hospital (KKH) last August spells hope for such patients, said Dr Kevin Lim, a senior consultant at its department of orthopaedic surgery. In the three- to four-hour procedure, a Vertical Expandable Prosthetic Titanium Rib (VEPTR, pronounced “vep-ter”) is fixed to the back of the rib cage to prevent it from collapsing any further. The adjustable titanium rod is curved to fit the back of the chest and spine. Hooks on both ends of the device are attached to two ribs, or to a rib and the pelvis, or to a rib and the spine.

Three young patients have undergone the procedure at KKH, said Dr Lim, who is the first doctor in the hospital to be trained in it. The youngest, Sririta Phikun, was only 14 months old when she had it done last August, while the other two were two and four years old. The procedure has been used in the United States, Europe, Australia, New Zealand, South Korea and Taiwan. Sririta, who turns two next Thursday, had a spine curved in the shape of an “S” when Dr Lim first saw her in 2009. She was only a few months old then. A big part of the curve was in her chest, compressing it severely. Many of her ribs were also fused from birth and some of her vertebrae were only half-formed. With her lungs trapped in such a confined space, their capacity was only 70 per cent that of a normal child, Dr Lim estimated. They would have been unable to grow properly and she would always be unable to exert herself without becoming breathless, he said.

Given her curved spine, she would also be unlikely to top 1.25m by the time she was 20 years old, he added. He separated Sririta’s fused ribs and implanted two rods – one on each side of her body – to hold the ribs apart. Each was about 15 to 20cm long, with one end hooked onto her ribcage and the other to her pelvic bone. Dr Lim said the treatment allows the rib cage to grow larger in volume and a larger chest allows more room for the lungs to expand and grow. A longer, straighter chest would also mitigate the spinal curvature, he said.

Every six to nine months, Sririta will have surgery again, until she is about 13 or 14 years old, to lengthen the rods to “expand the chest a little bit more, allowing for further lung growth”, he said. After that age, she may have spinal fusion surgery to fix her spine in place. The drawback for the VEPTR procedure is its prohibitive cost. Dr Tan Chong Tien, an orthopaedic surgeon at Mount Elizabeth Medical Centre, said he has offered it to three patients, but none chose to proceed because it could cost $50,000.

At KKH, it costs about $25,000 to $40,000. A titanium rod alone costs $15,000 to $50,000. MediShield, the Government’s health-insurance scheme covering serious illnesses, cannot be used to pay for the procedure as the scheme does not cover congenital conditions. But earlier this month, Health Minister Khaw Boon Wan said the Health Ministry is studying the feasibility of extending MediShield to cover more illnesses, including mental and congenital conditions.

Sririta’s father, cargo assistant Kong Kok Keong, 34, had help from the KKH Health Endowment Fund and a private charity to cover more than 85 per cent of the cost of his daughter’s initial surgery and hospitalisation, which came up to about $26,000. KKH declined to reveal how the other two patients paid for their operations. The surgery to lengthen Sririta’s implants cost approximately $1,100.

This was largely covered by Medifund, a national endowment fund to help the needy pay their medical bills. Mr Kong said he was devastated to learn about his younger daughter’s spinal problem, which he had never heard of. He has not revealed all the details of Sririta’s condition to her Thai mother, Ms Tip Phikun, 27, so as not to worry her unduly. Now Sririta will have a shot at growing up more normally, like her sister, who is four years old and healthy. Mr Kong said in Mandarin: “Surgery is the only way to help Sririta and I’m thankful for KKH’s help.”

  Ask the Specialists - Free Doctor Q&A  
    Advanced Care Planning
Take this opportunity to ask our experts on what advance care planning is all about, as well as the other directives.
    Previous Q&As
Check out our archive for all our previous doctor's Q&As!
*Latest Update: Speech and Language Problems in Children, Gynaecological Cancers: Cervical and Ovarian Cancers, Colorectal Problems, Screening, Risks & Symptoms
e-Appointment Online
Health Buddy App