An 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.”