The Titanium Rib Project - Journal of San Antonio

by Kelly Bratusek

In downtown San Antonio, CHRISTUS Santa Rosa Children’s hospital is the home to the world’s first titanium rib implant surgery (CHRISTUS Thoracic). Two doctors created the innovation and perfected an operation that saved the lives of three hundred infants and children in the fifteen years after the procedure’s development (Sansom).

Invented for the treatment of diseases such as scoliosis or conditions such as fused ribs, small chests, or missing ribs, including Jeunes Syndrome and Jarcho-Levine syndrome. The Vertical Expandable Titanium Rib Prosthesis, or VEPTR, was created by Dr. Robert M. Campbell, a pediatric orthopedist researching treatment of “rare thoracic malformations (otherwise known as rare chest deformities) in infants and children” at Santa Rosa with the help of his colleague Melvin Smith, M.D., the general pediatric surgeon at the hospital. Smith and Campbell, directors of the Thoracic Institute at Santa Rosa, performed the first of many titanium rib implant surgeries in 1989 on an infant named Christopher Cardenas.

Children as young as six months can undergo a titanium rib implant operation. Titanium, a biocompatible (well accepted by surrounding tissues when surgically implanted) and lightweight metal, was chosen mainly because of its failure to interfere with magnetic resonance imaging, or MRI scans (CHRISTUS Frequently). The rib must be expandable because the child’s body and chest will continue to grow and develop; the patients must have the ribs enlarged every six months by outpatient surgery until full skeletal maturity occurs (around age fourteen in females and sixteen in males) (Lambert). The infection rate resulting from this type of procedure compares equally to other medical procedure infection rates (Lambert). Doctors Campbell and Smith named the newly discovered disease “Thoracic Insufficiency Syndrome” (described as the inability of the thorax to support normal respiration or lung growth) in 1993 and have described it in four landmark papers in orthopedic journals (Lambert). They have taught the surgery procedure and techniques to other hospitals throughout the United States and the world, and have developed five new operations using the titanium rib (Lambert). The rib finally became FDA approved in 2004 (CHRISTUS Titanium).

Expected to live only seventy-two hours, Christopher Cardenas surprised all doctors when he exceeded those few days. He came into the world with a rare birth defect; on his right side, seven of his twelve ribs were missing, as well as the chest muscles (Shaw). Since the rib cage acts as a support and protection for the lungs and other organs, the lack of support meant the organs would shift, most likely causing his right lung to grow abnormally and scoliosis to develop (Shaw). Respirator-dependent for seven months, he and his family moved to San Antonio where they met Dr. Smith. According to Smith, Chris had a strong heart and a potentially good right lung that “just needed a place to work” (Shaw). After consulting with Dr. Smith, Dr. Campbell used pins normally used to set bone fractures to create an artificial chest wall that served as a short-term solution to the problem. Two years later, Campbell finished inventing a long-term prosthetic implant, the expandable titanium rib (Shaw). The successful operation allowed Chris Cardenas to survive his childhood; today he prepares to celebrate his nineteenth birthday.

Beginning in 1990, children with rare spine and rib cage diseases have come to CHRISTUS Santa Rosa Children’s Hospital from all over the world, making it the global leader in the field [(CHRISTUS Titanium) (CHRISTUS Thoracic)]. Campbell and Smith still perform the surgery at Santa Rosa today, along with 2 additional teams of orthopedic and general surgeons.. At least 279 children have had the lifesaving surgery at the hospital since it began in 1989 and ninety have had the surgery at other children’s hospitals in Pittsburgh, Boston, Salt Lake City, Los Angeles, Seattle and Philadelphia [(CHRISTUS Frequently) (Lambert)].

CHRISTUS Santa Rosa Children’s Hospital. Frequently Asked Questions. 21 Nov. 2006.

CHRISTUS Santa Rosa Children’s Hospital. Thoracic Institute- Titanium Rib Program. 21 Nov. 2006.

CHRISTUS Santa Rosa Children’s Hospital. Titanium Rib Project chronology. 21 Nov. 2006.

Lambert, Arlene. Titanium Rib Project (VEPTR). 21 Nov. 2006.

Sansom, Will. “Reinventing the Rib.” The Mission. 21 Nov. 2006.

Shaw, Joanne, ed. “Titanium rib- giving kids room to breathe.” The Mission. 1998. 21 Nov 2006.