Posterior Spinal Fusion With Rib Resection Allows for Improved Deformity Correction as Well as Patient Satisfaction.

STUDY

DESIGN

Retrospective cohort study.

OBJECTIVE

This study aimed to compare radiographic and clinical outcomes in adolescent idiopathic scoliosis (AIS) patients undergoing posterior spinal fusion (PSF) with and without thoracoplasty.

BACKGROUND

Scoliosis is a three-dimensional deformity. As a result, patients often have an associated rib cage deformity, with clinical and aesthetic implications. Direct vertebral rotation (DVR) allows for some reduction of the rib hump; however, the deformed ribs remain deformed. Rib resection has been utilized to further reduce the rib hump, however, there are concerns of increased pain, operative time, and blood loss.

MATERIALS AND

METHODS

Retrospective review of 400 AIS patients undergoing PSF between 2018 and 2023. Patients were stratified based on those who underwent rib resectioning (RR) and those who did not [non-rib resection (N-RR)]. Radiographic, surgical, and clinical outcomes were compared. Clinical outcomes were collected utilizing SRS-22 and our institution's activity questionnaire, validated through "test-retest" method. All data are presented as medians, IQR, frequencies, and percentages. Fisher exact, χ 2 , and Wilcoxon rank-sum tests were used.

RESULTS

One hundred fifty-three patients were in the RR group, and 247 were in the N-RR group. Preoperative rib hump was not statistically significant between the two groups ( P = 0.49). Final rib hump was 16.3 mm in RR patients and 29.8 mm in N-RR ( P < 0.001). RR had 60.5% rib hump correction; N-RR had 30.4% correction ( P < 0.001). Patient-reported self-image ( P = 0.02) and mental health ( P = 0.01) scores had significantly improved in RR. No differences in 90-day complication rates ( P = 0.19) or self-reported return to activities ( P > 0.05).

CONCLUSION

Rib resectioned patients had approximately double the amount of rib hump correction at 60.5%, compared with those who did not undergo rib resectioning at 30.4%, with no increase in the rate of complications. RR patients had improved self-reported self-image and mental health scores, with no difference in timing for return to activities.