Thoracoplasty in Thoracic Adolescent Idiopathic Scoliosis

Materials and Methods: Eighty-seven patients with thoracic AIS (mean age, 14.4 years) treated by pedicle screw instrumentation and a minimum follow up 2 years were retrospectively analyzed. Patients were divided into three groups; N-T group (no thoracoplasty with iliac bone graft, n=37), T-N-DVR [thoracoplasty with no direct vertebral rotation (DVR), n=20] and T-DVR group (thoracoplasty with DVR, n=30). In the T (T-N-DVR+T-DVR) group, 5 to 7 ribs were resected and used as bone graft. Patients were evaluated for deformity correction, pulmonary function, size of rib hump, operating time, complications and clinical outcomes (SRS-30).

Results: In the N-T group, the thoracic curve was corrected from 53 to 16 (69% correction), and in the T-N-DVR group from 55 to 18 (69%) and in the T-DVR group from 54 to 10 (81%). There was no difference in postoperative spinal balance and pulmonary function among the three groups. Rib hump was corrected from 31mm to 19mm (35% correction) in N-T group, from 32mm to 13mm (53%) in T-N-DVR and from 32mm to 9mm (69%) in T-DVR. The T group showed significantly better correction of rib hump and clinical outcome score in the SRS-30 than N-T group. The operating time was 172 minutes in the N-T group, 190 minutes in the T-N-DVR group and 216 minutes in the T-DVR group. There were 8 iliac donor site problems in the N-T group and 3 pleural effusions in the T group, which had no adverse effect in the final result. All patients accomplished bony union.

Conclusions: Thoracoplasty showed significantly better rib hump correction, satisfactory clinical outcomes without pulmonary function compromise or iliac bone graft site morbidity in the treatment of thoracic AIS with pedicle screw instrumentation.