title: Multiple concave rib head resection improved correction rate of posterior spine fusion in treatment of adolescent idiopathic scoliosis.
abstract: BACKGROUND
  Hybrid constructs have been widely used to surgically correct thoracic adolescent idiopathic scoliosis (AIS). To enhance the correction obtained with hybrid constructs, we perform concave rib head resection and convex costovertebral release as posterior release procedures. The objective of the study was to evaluate coronal and sagittal curve correction in patients with adolescent idiopathic scoliosis (AIS) treated with hybrid constructs combined with concave rib head resection and convex transverse process resection as posterior release procedures.
  
  
  METHODS
  The records of 24 patients with Lenke type 1 or 2 AIS treated with hybrid constructs combined with posterior release procedures were retrospectively reviewed. The mean age at surgery was 14.3 years. The mean follow-up period was 33.0 months (range, 24-60 months). Radiographs were evaluated before surgery, immediately postoperatively, and at latest follow-up.
  
  
  RESULTS
  The average preoperative Cobb angle of the main thoracic (MT) curve was 58.1 ± 12.6° (range, 45-88°). The MT curve was corrected to 12.8 ± 9.0° (range, 0-38°) immediately after surgery. At the latest follow-up, the average Cobb angle was 13.6 ± 9.9° (range, 0-44°; correction, 77.5 ± 14.0%). The average loss of coronal correction was 0.8°. The average preoperative flexibility of the MT curve was 54.6 ± 17.4%. The average Cincinnati correction index was 1.53 ± 0.48 at the latest follow-up. The average preoperative thoracic kyphosis (TK) was 13.7 ± 12.0° (range, -12-34°). Immediately after surgery, TK was corrected to 18.6 ± 5.9° (range, 10-29°). At the latest follow-up, TK measured 18.1 ± 6.5° (range, 6-32°).
  
  
  CONCLUSIONS
  Hybrid instrumentation combined with concave rib head resection and convex transverse process resection as posterior release procedures achieved satisfactory coronal and sagittal curve correction with little loss of correction at 2-year follow-up.
authors.affiliation: Department of Orthopaedic Surgery, Dokkyo Medical University, Tochigi, Japan; Department of Orthopaedic Surgery, Osaka City General Hospital, Osaka, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Namikawa
authors.affiliation: Department of Orthopaedic Surgery, Dokkyo Medical University, Tochigi, Japan. Electronic address: tane@dokkyomed.ac.jp.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Taneichi
authors.affiliation: Department of Orthopaedic Surgery, Dokkyo Medical University, Tochigi, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Inami
authors.affiliation: Department of Orthopaedic Surgery, Dokkyo Medical University, Tochigi, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Moridaira
authors.affiliation: Department of Orthopaedic Surgery, Dokkyo Medical University, Tochigi, Japan.
authors.forename: Daisaku
authors.initials: D
authors.lastname: Takeuchi
authors.affiliation: Department of Orthopaedic Surgery, Dokkyo Medical University, Tochigi, Japan.
authors.forename: Yo
authors.initials: Y
authors.lastname: Shiba
authors.affiliation: Department of Orthopaedic Surgery, Dokkyo Medical University, Tochigi, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Nohara
mesh_terms: D000293:Adolescent; D001863:Bone Screws; D016025:Bone Transplantation; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011859:Radiography; D012189:Retrospective Studies; D012272:Ribs / Q000000981:diagnostic imaging / Q000601:surgery*; D012600:Scoliosis / Q000175:diagnosis / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D019616:Thoracic Surgical Procedures / Q000295:instrumentation*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D013905:Thoracoplasty / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome