The vertical expandable prosthetic titanium rib (VEPTR) is a pediatric device originally developed for chest wall reconstruction in children with missing or fused ribs. Use has expanded to managing spinal deformity in children with critical years of thoracic growth remaining. In the era of remote lengthening technology, the primary indications for a VEPTR are children with a volume depletion deformity of the chest/spine or a spinal deformity too stiff or compact for remote lengthening technology. One component of the VEPTR, the gantry, was uniquely created to support the parasol rib deformity seen with spinal muscular atrophy. VEPTR surgery can help a child wean off pulmonary support.