Minimally Invasive, Endoscopic, Internal Thoracoplasty for the Treatment of Scoliotic Rib Hump Deformity
Object: Patients with idiopathic scoliosis often have a noticeable rib deformity which often persists following corrective surgery. Open thoracoplasty has been the traditional method of reducing rib deformity. Recently, however, video-assisted thoracoscopy (VATS) has been used to perform thoracoplasty. There have been no long term follow-up studies on VATS thoracoplasty. There have been no outcome scores to assess the results of thoracoplasty procedures. We present our experience with VATS thoracoplasty with long term follow-up and propose an outcome scoring system for thoracoplasty.
Methods: Between 1998 and 2000, four patients (ranging in age from 14 to 53 yo) underwent VATS thoracoplasty (performed by the senior surgeon – R.S.) for significant rib hump deformity (mean 5cm, range 4 to 6 cm of rib deformity height) associated with idiopathic scoliosis. Patients were followed for a mean of 40 months after surgery (range 33 to 50 mo). Outcomes were assessed by patient questionnaire with the Mummaneni/Sasso criteria.
Mummaneni/Sasso Scores For Results of Thoracoplasty
Excellent: Rib hump absent, patient fully satisfied with cosmetic result of VATS thoracoplasty. Minimal or no postoperative chest wall pain in area of rib removal (on NSAIDS only). Good: Mild residual rib hump, patient satisfied with cosmetic result. Mild postoperative chest wall pain in area of rib removal (requires occasional narcotics).
Fair: Rib hump diminished but still noticeable, patient equivocal about cosmetic results. Moderate postoperative chest wall pain in area of rib removal (requires daily narcotics).
Poor: No change in rib hump, patient unsatisfied. Significant postoperative chest wall pain in area of rib removal.
Results: Two patients had an excellent outcome, and two patients had a good outcome by the Mummaneni/Sasso criteria. There were no introperative or postoperative complications. All patients were pleased that they had chosen to have VATS internal thoracoplasty.
Conclusion: VATS provides an alternative, minimally invasive route to perform thoracoplasty. VATS incisions are much smaller and more cosmetically appealing than open thoracoplasty incisions. Long term follow-up indicates good to excellent patient outcomes.