Evaluation of the Safety and Efficacy of the Synthes Vertical Expandable Prosthetic Titanium Rib in Children with Congenital Scoliosis and Rib Fusion

• a - Synthes Spine

Purpose: To review the natural history and results of surgical treatment of patients with fused ribs and congenital scoliosis.

Method: Radiographs of 32 patients between six months and 12 years of age (girls) or 14 years of age (boys) with congenital scoliosis and concave rib fusion were reviewed. For inclusion, Cobb angles were at least 35º, with progressive deformity. Cobb angle and trunk height data were measured on standard radiographs at initial exam, pre-op, post-op, and at last follow-up. Thoracic spinal height data were compared to normal thoracic height of age-matched norms.

Results: Eight patients had no surgery, 19 underwent fusion in situ, and 5 had corrective osteotomies. Average age at initial visit was 4.9 years (0.8 to 12 years), and average follow-up was 6.2 years (2 to 14.8 years). Average Cobb angle was 63.6º (35 to 94º). All patients in the nonsurgical group had an increase in Cobb angle. Curves in 12/19 patients (63%) with fusion in situ and 4/5 patients (80%) with corrective osteotomies were either maintained or decreased. Growth of the thoracic spinal height was decreased compared to that of age-matched norms in all patients, with the least amount of growth observed in the corrective osteotomy group.

Conclusion: In children with fused ribs and congenital scoliosis, severity of thoracic deformity progresses with growth. Our results suggest that corrective osteotomy gives the best chance of maintaining or improving the Cobb angle but allows for the least amount of growth in thoracic spinal height.

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