Institutional members access full text with Ovid®

Isolated Percutaneous Thoracoplasty Procedure for Skeletally Mature Adolescent Idiopathic Scoliosis Patients, With Rib Deformity as Their Only Concern: Short-term Outcomes

Yang, Jae Hyuk MD*; Bhandarkar, Amit Wasudeo MBBS, MS*; Kasat, Niraj Sharad MD*; Suh, Seung Woo MD, PhD*; Hong, Jae Young MD; Modi, Hitesh N. MS, PhD*; Hwang, Jin Ho MD

doi: 10.1097/BRS.0b013e3182784cdc
Deformity

Study Design. Prospective case series study.

Objective. To study the effect of percutaneous thoracoplasty–only procedure on curve pattern in mature adolescent idiopathic scoliosis (AIS).

Summary of Background Data. The rib hump prominence on the convex side is the major cosmetic concern among patients with AIS. Thoracoplasty combined with spinal fusion is a commonly used procedure in scoliosis. However, there are no studies regarding the effect of isolated thoracoplasty procedure on curve pattern in skeletally matured patients with AIS.

Methods. The study involved 7 skeletally matured female patients with AIS. The convex rib hump deformity was measured preoperatively using hump height and hump angle. We performed thoracoplasty without spinal fusion in patients with the Cobb angle less than 40° but with prominent hump deformity. Thoracoplasty was performed percutaneously using 1 or 2 transverse incisions along the rib hump, and apex portions of the deformed ribs were resected. The Cobb angle was measured before surgery, immediately after surgery, and at final follow-up visit. In all cases, clinical satisfaction was assessed using the Scoliosis Research Society Instrument (SRS-22 questionnaires) and trunk appearance perception scale before surgery and at final follow-up visit.

Results. The mean patient age was 20.24 years and an average of 4 ribs were resected. The mean preoperative hump height and hump angle of 38.14 mm and 14.14° improved to 11.70 mm and 11.42° respectively, after surgery (P = 0.018 and 0.042). Preoperative and the final follow-up mean Cobb angles were 35.43° and 45.00°, respectively (P = 0.028). On average, the mean thoracic curve progressed by 9.57°. Preoperative Scoliosis Research Society Instrument SRS-22 questionnaires and trunk appearance perception scale scores of 4.09 and 2.57 respectively improved to and 4.26 and 3.66 after surgery (P = 0.126 and 0.014).

Conclusion. Percutaneous thoracoplasty–only procedure gives significant rib humps correction and satisfactory clinical outcome. However, progression of the curve was observed after surgery. This suggests that the convex ribs function as a buttress for curve progression.

Patients with significant rib hump deformity but with acceptable scoliosis curve at skeletal maturity may require thoracoplasty without spinal fusion. There was significant progression of curve after thoracoplasty in patients with idiopathic scoliosis. This suggests that ribs on the convex side of the curve have a buttressing function in curve progression.

*Department of Orthopedics, Scoliosis Research Institute, Korea University Guro Hospital, Seoul, Korea

Department of Orthopedics, Korea University Ansan Hospital, Gyeonggi-do, South Korea

Department of Orthopaedic Surgery, Division of Pediatric Orthopaedics, Yonsei University College of Medicine, Severance Children's Hospital, Seoul, Korea.

Address correspondence and reprint requests to Jin Ho Hwang, M.D, Yonsei University Medical Center, Severance Children's Hospital, Sinchon-dong, Seodaemun-gu, Seoul, Korea; E-mail: scoliosis@yuhs.ac

Acknowledgment date: December 8, 2011. First revision date: March 18, 2012. Acceptance date: April 24, 2012.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Korea Healthcare Technology R&D Project, Ministry for Health, Welfare & Family Affairs, and Republic of Korea grant funds (A110416) were received to support this work.

No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

© 2013 Lippincott Williams & Wilkins, Inc.