Convex short length rib resection in thoracic adolescent idiopathic scoliosis.

BACKGROUND

Although it brings satisfactory rib hump correction, concomitant thoracoplasty with surgical correction of scoliosis decreases pulmonary function values. To achieve satisfactory rib hump correction and avoid impairment to pulmonary function, we design a new kind of thoracoplasty-convex short length rib resection (CSLRR). This study is to evaluate the effect and outcome of CSLRR in conjunction with pedicle screw instrumentation.

METHODS

Seventy patients with thoracic adolescent idiopathic scoliosis treated by pedicle screw instrumentation were retrospectively analyzed after a minimum follow-up of 2 years. Patients were divided into 3 groups: C-T group (conventional thoracoplasty, n =20), N-T group (no thoracoplasty, n=24), and CSLRR group (n=26). Patients were evaluated for height of rib hump, deformity correction, balance, pulmonary function, and complications.

RESULTS

The correction rates of hump height were 74.1% in the C-T group, 47.1% in the N-T group, and 63.2% in the CSLRR group, respectively. The CSLRR group showed significantly better correction of rib hump than the N-T group. In thoracic hypokyphosis correction, the CSLRR group was superior to the N-T group with statistical significance. There were no significant differences in proximal thoracic, main thoracic and lumbar Cobb angle, coronal and sagittal balance, and lumbar lordosis at the final follow-up among 3 groups. Three months after the operation, both absolute values and percent-predicted values of forced vital capacity and forced expiratory volume in 1 second in the N-T group and CSLRR group were better than that in the C-T group. Two years after the operation, absolute values of forced vital capacity and forced expiratory volume in 1 second in the N-T group and CSLRR group were better than that in the C-T group. There were 2 hemothorax in the C-T group and 1 pleural effusion in the CSLRR group.

CONCLUSIONS

CSLRR showed significantly better rib hump and thoracic hypokyphosis correction without pulmonary function compromise in the treatment of thoracic adolescent idiopathic scoliosis with pedicle screw instrumentation.

LEVEL OF EVIDENCE: Therapeutic-level IV retrospective study.