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Direct Vertebral Body Derotation, Thoracoplasty or Both: Which is Better with Respect to Inclinometer and SRS‐22 Scores?: E‐Poster #223

Hwang, Steven W. MD; Samdani, Amer F. MD; Newton, Peter O. MD; Lonner, Baron S. MD; Marks, Michelle C. PT, MA; Bastrom, Tracey MA; Cahill, Patrick J. MD; Betz, Randal R. MD

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Spine Journal Meeting Abstracts: 2010 - Volume - Issue - p 138–139
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Summary: We evaluated 203 patients from a prospective, longitudinal database to ascertain which surgical techniques of thoracoplasty (Th), direct vertebral body derotation (DVBD), or both (Th/DVBD) achieved the best post‐op results by inclinometer and SRS scores. Patients with mild rib prominences have equivalent post‐op inclinometer values for all three groups, but higher SRS self‐image scores for Th/DVBD. For larger rib humps, significantly better results are achieved with thoracoplasty, but SRS scores remain comparable.

Introduction: DVBD and Th are powerful tools for correction of rib humps in patients with AIS. We evaluated Th, DVBD, and Th/DVBD with respect to post‐op inclinometer readings and SRS scores to determine which provides the best correction of rib hump and patient satisfaction.

Methods: A prospective longitudinal database was queried to identify AIS patients who underwent a PSF with pedicle screws and 2 yrs follow‐up. 203 patients were identified and divided into 3 groups: 1) Th alone (N=30), 2) DVBD alone (N=122), and 3) both Th/DVBD (N=51). Patients were subdivided into categories based on their pre‐op inclinometer reading: 1) ≤ 9° (mild), 2) 10‐15° (moderate), and 3) ≥ 16° (severe). Pre‐ and post‐op inclinometer readings and SRS scores were compared using ANOVA.

Results: Overall, the groups were similar preoperatively except for the DVBD group having higher percent thoracic flexibility. The preoperative rib hump values were Th=13.2, DVBD=14.0, and Th/DVBD=12.9 (p=0.27). Taken collectively, the post‐op 2‐year inclinometer readings were similar for all three groups (Th=5.2, DVBD=7.0,Th/DVBD=5.6, P=0.66). However, the SRS‐22 self‐image scores were significantly better for patients having both Th/DVBD (Th=3.4, DVBD=3.4, Th/DVBD=3.8, P<0.01). When patients were stratified by severity of pre‐op rib humps, all patients with mild prominences achieved similar corrections, although SRS self‐image scores were highest in the Th/DVBD group. In patients with moderate and severe pre‐op rib prominences, the addition of Th was necessary for optimal rib hump correction, but there was no difference in SRS‐22 domains (Table 1).

Conclusion: Our results suggest that Th alone, DVBD alone, or both Th/DVBD provide equivalent inclinometer results in patients with mild preoperative rib humps, but higher SRS‐22 self‐image scores are achieved using both Th/DVBD. For more severe rib prominences (> 10°), better inclinometer readings are achieved with thoracoplasty, although SRS‐22 self‐image scores are comparable.

Significance: Although thoracoplasty provides optimal correction in patients with moderate to severe rib humps, SRS self image scores are equivalent when compared to direct vertebral body derotation alone.

© 2010 Lippincott Williams & Wilkins, Inc.