STUDY DESIGN A single-center, prospective study. OBJECTIVE To investigate the effect of rib anomaly on surgical curve correction outcome in congenital scoliosis. SUMMARY OF BACKGROUND DATA The presence of rib anomalies may complicate surgical correction of congenital scoliosis. The outcome of surgical correction, however, has not been documented in scoliotic patients with and without rib deformity. METHODS Percent Cobb angle decrease (CAD) after operation was calculated in 94 patients with congenital scoliosis. Posterior segmental pedicle screw instrumentation (posterior approach) with or without previous anterior spinal release and fusion (anterior approach) was the method of correction. The impact of vertebral anomaly and rib deformity on CAD was examined. RESULTS Although the type of vertebral anomaly had no significant effect on the mean CAD, it was significantly lower in 56 patients with rib deformity compared with that in the remaining patients without rib deformity (35.14%±15.83% vs. 51.54%±17.82%, P<0.001); particularly in those with complex, unilateral rib abnormalities, and in those with same-level vertebral and rib deformities. Patients' sex and age at the time of operation, rib number abnormality, and the type of operation (ie, posterior-only approach vs. anterior and posterior approach) did not contribute significantly to Cobb angle change after operation. CONCLUSIONS Concomitant rib deformities, particularly of complex and unilateral types, significantly compromise operative curve correction outcome in congenital scoliosis.

The Effect of Concomitant Rib Deformity in Congenital Scoliosis on Spinal Curve Correction After Segmental Pedicle Screw Instrumentation.

Introduction: Concave ribs are in a position to act as a butttress preventing the reduction of the spine towards the midline. Segmental concave ribs osteotomy decrease the buttress effect increases the flexibility of the curve and allow the spine to approach a more mideline position. Purpose: To analyze radiographic and perioperative data in patients undergoing posterior thoracic instrumented fusion and concave ribs osteotomies. Methods: 34 patients with rigid thoracic curves treated with hybrid constructs (hooks, wires and pedicle screw) and concave rib osteomies( averaged 5) between 2000 and 2003 are included. All patients obtained pre-operative upright and bending films and postoperative upright films. Cobb angle was collected and three parameters were assessed: percent flexibility, percent scoliosis correction and the percent bend corecction. Main age was 14 years with 20 females and minimun follow up 1 year. Results: There were 13 A.I.S., 8 neuromuscular cases and the rest associate to different pathologies (syringomyelia, cardiopathy ect.). Preoperative thoracic curve averaged 78(60–112); percent bend correction veraged 25% and postoperative correction averaged 58%. There were no neurological complications, 4 patients developed pulmonary complications ( pleural effusion) who required suction drenage. Conclusions. Rigid curves undergoing concave rib osteotomies achieved a postoperative curve that was 58% of the preoperative bend curve. Concave rib osteomomies increase flexibility of severe rigid curves avoiding anterior realese in the great majority of large curves with minimmal pulmorary complication. Overlapping the osteotomized ribs on the concave rod the chest asymmetry improves and the cosmetical result of the operation is improved.

Radiographic evaluation of concave rib osteotomies in the surgical treatment of high magnitude thoracic curves. review of 34 patients.

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Radiographic evaluation of concave rib osteotomies in the surgical treatment of high magnitude thoracic curves. review of 34 patients.