Thoracoplasty in thoracic adolescent idiopathic scoliosis.
METHODS
Retrospective study.


OBJECTIVE
To evaluate the effect and outcome of thoracoplasty in conjunction with pedicle screw instrumentation in the treatment of thoracic adolescent idiopathic scoliosis (AIS).


BACKGROUND
Some spine surgeons recently think more correction of hump deformity using pedicle screws without thoracoplasty. Although thoracoplasty has been conventional treatment of rib hump, there are few papers about the results of pedicle screw instrumentation and concomitant thoracoplasty.


METHODS
Eighty-seven patients with thoracic AIS (mean age, 14.4 years) treated by pedicle screw instrumentation were retrospectively analyzed after a minimum follow-up of 2 years. Patients were divided into 3 groups; N-T group (no thoracoplasty with iliac bone graft, n = 37), T+N-DVR [thoracoplasty without direct vertebral rotation (DVR), n = 20] and T+DVR group (thoracoplasty with DVR, n = 30). In the T (T+N-DVR and T+DVR) group, 4 to 8 ribs were resected and used for bone graft. Patients were evaluated for deformity correction, balance, pulmonary function, height and angle of rib hump, clinical outcomes (SRS-30), and complications.


RESULTS
In the N-T group, the thoracic curve was corrected from 53 degrees to 16 degrees (69% correction), in the T+N-DVR group from 55 degrees to 18 degrees (69%) and in the T+DVR group from 54 degrees to 10 degrees (81%). There was no difference in postoperative spinal balance and pulmonary function among the 3 groups. The correction rates of hump height and angle were 35% and 38% in the N-T group, respectively, 57% and 58% in the T+N-DVR, and 70% and 72% in the T+DVR. The T group showed significantly better correction of rib hump and self-image score in the SRS-30 questionnaire than the N-T group. There were 8 iliac donor site problems in the N-T group and 3 hemothorax in the T group, which had no adverse effect in the final result.


CONCLUSIONS
Thoracoplasty showed significantly better rib hump correction, satisfactory clinical outcomes without pulmonary function compromise, or iliac bone graft site morbidity in the treatment of thoracic AIS with pedicle screw instrumentation.
Suk
Se-Il
SI
Seoul Spine Institute, Inje University Sanggye Paik Hospital, Seoul, Korea. seilsuk@unitel.co.kr
Kim
Jin-Hyok
JH
Kim
Sung-Soo
SS
Lee
Jeong-Joon
JJ
Han
Yong-Tak
YT
D000293:Adolescent; D000328:Adult; D001863:Bone Screws; D016025:Bone Transplantation / Q000009:adverse effects; D002648:Child; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D007085:Ilium / Q000637:transplantation*; D008171:Lung Diseases / Q000209:etiology / Q000503:physiopathology; D008297:Male; D011187:Posture; D011859:Radiography; D012189:Retrospective Studies; D012272:Ribs / Q000637:transplantation*; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D012649:Self Concept; D011795:Surveys and Questionnaires; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D013905:Thoracoplasty / Q000009:adverse effects; D016896:Treatment Outcome; D014797:Vital Capacity