Introduction: This study investigated the impact of thoracoplasty in adolescent idiopathic scoliosis (AIS) patients' clinical and radiographic appearance, and their outcome measures. To avoid the argument that pedicle screw constructs may obviate the need for thoracoplasty, only patients treated with hybrid constructs were included.
Methods: 103 patients with thoracic (Lenke types 1–4) curves who underwent posterior spinal fusion (PSF) using hybrid constructs were studied. There was a minimum 2‐year followup. 21 of these patients had thoracoplasty (Group A) and 82 did not (Group B). Thoracic curve magnitude, clinical rotation as measured by scoliometer, radiographic rotation (Nash‐Moe), body mass index, and SRS‐30 measures (appearance, satisfaction, pain) were evaluated preoperatively and two years postoperatively.
Results: Preoperatively, the curve magnitudes were significantly greater in the thoracoplasty group (62.00 vs 57.50). Despite this, there were no significant differences between groups (A/B) with regard to clinical thoracic rotation (15.3/14.7) or radiographic thoracic rotation. Body mass index was similar (21.9/21.8). Of the three SRS domains tested, the preoperative satisfaction score was higher in the thoracoplasty group, but no differences were found in pain or appearance scores. Two years postoperatively, the curve magnitude remained significantly greater in the thoracoplasty group (28.60/22.20). There were no significant differences between groups (A/B) with regard to clinical rotation (12.2/11.3), radiographic rotation, body mass index (22.5/22.6), or any of the three SRS domain scores.
Conclusion: Over time, when AIS patients treated with PSF and thoracoplasty were compared to those who did not undergo thoracoplasty, there were no differences between groups in residual clinical rotation (as measured by scoliometer), radiographic rotation, or SRS domains of appearance, satisfaction, or pain. Knowing that there will be no recognizable improvements in these parameters when a thoracoplasy is performed, surgeons should provide other reasons if they consider thoracoplasty to be indicated in the surgical treatment of AIS.
Significance: Thoracoplasty adds little, if any, benefit to the outcome of surgery in adolescent idiopathic scoliosis.