Spine: Spinal Growing Instrumentation and Physical Therapy Fact Sheet
These instructions are for patients undergoing spinal growing instrumentation surgery, also called VEPTR or MAGEC procedures at Children's Hospital of Philadelphia (CHOP).
Important information:
Patients undergoing spinal growing instrumentation surgery may receive VEPTR rods or MAGEC rods. VEPTR stands for Vertical Expandable Prosthetic Titanium Rib and MAGEC stands for MAGnetic Expansion Control. These procedures improve breathing for children with thoracic insufficiency syndrome. The chest wall is expanded by inserting an adjustable rod into the child's chest wall and extending it slowly multiple times a year, providing room for lung growth.
Patients receiving the VEPTR or MAGEC rod surgery may benefit from a physical therapy consultation or treatment at certain stages due to their difficulty breathing and abnormal rib cage development. They may have tight or weak muscles or poor endurance. They may have difficulty coordinating breathing, moving around, or completing daily tasks. The goal of physical therapy in the VEPTR/MAGEC rod process is to help children through these challenges, track their changes over time, and suggest community or home therapy options.
Your child will see a CHOP physical therapist as outlined below and they will make recommendations and help coordinate care with your outpatient therapist.
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There will be an outpatient visit before the spinal growing instrumentation surgery to learn about your child's current ability and movement. Education about what to expect is also provided to your family.
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A physical therapist will meet with your child during their inpatient stay to assess post-surgical mobility and equipment needs. They will also help them begin to move around, and ensure they are safe for discharge home.
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After discharge from the hospital, your child might need outpatient treatment. If they are already receiving outpatient treatment, they may need more frequent services.
Depending on your child's needs, the physical therapist may examine:
Important information for your community physical therapist:
As these are specialized surgeries, community therapists may benefit from additional guidance.
Patient treatment should focus on maximizing chest wall mobility and mechanics, including vertebral and thoracic cage mobility, respiratory muscle training, and neuromotor re-education. Additional interventions that have been found to improve outcomes in this population include extensive caregiver education, flexibility management, and focused gait training. Consider the following treatment interventions:
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Muscle strengthening, especially of core and proximal muscle groups
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Muscle flexibility, especially of the trunk as well as proximal muscle groups
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Endurance training
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Airway clearance techniques and respiratory muscle training
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Postural control and neuromuscular re-education
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Maximizing chest wall mobility
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Progressing developmental motor and functional skills
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Monitoring skin integrity and scar management
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Safety instructions for spinal growing instrumentation surgery:
For six weeks after VEPTR or MAGEC rod insertion, follow the safety precautions below:
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No lifting under arms, must scoop under buttocks to lift
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Do not raise both arms overhead at the same time
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Limit bending or twisting of the spine
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No baths or swimming until all incisions heal.
After six weeks, encourage your child to participate in their normal daily activities as tolerated.
There are no precautions after the expansion of the device.
Before the rods are placed:
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Practice caring for and playing with your child within the limits of the above precautions.
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Perform exercises and stretches as taught to you by a physical therapist.
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If your child has any equipment, be sure to inform your vendor of potential adjustments after surgery.
Reviewed on January 31, 2013, by Domenica Platenecky, PT, DPT, PCS