Rib Resection and Rib Deformity Correction: Evaluation by Scoliometer
• a - DePuy-AcroMed Corporation
Purpose: Rib deformity associated with thoracic adolescent idiopathic scoliosis (AIS) is frequently more of a concern to patients than the curvature of the spine. This prospective multicenter study was performed using the scoliometer to compare the change in rib asymmetry as a result of performing versus not performing a rib resection in addition to correcting the spinal curvature.
Materials and Methods: Patients who had a diagnosis of AIS with a structural thoracic curve (Lenke type 1) of sufficient magnitude to require surgery were eligible to be enrolled in this IRB-approved study. After obtaining informed consent, patients were evaluated with preoperative and subsequent two-year postoperative erect AP and lateral radiographs, as well as a forward bend test using the scoliometer to measure the thoracic and lumbar trunk asymmetry. Patients were divided into four groups based on the type of surgical fusion procedure: Open anterior instrumentation with rib resection (24 patients), thoracoscopic anterior instrumentation without rib resection (21 patients), posterior instrumentation with rib resection (8 patients), and posterior instrumentation without rib resection (14 patients).
Results: See Table 1
Thoracic curve improvement and change in thoracic scoliometer measurement were evaluated statistically using the paired samples test. All changes were significant to p<0 .001.There was no statistically significant difference between the four groups in correction of thoracic curves, or asymmetry as measured by scoliometer.
Conclusions: All four instrumentation techniques (anterior open or thoracoscopic, posterior with or without rib resection) of correcting Lenke type 1 curves provide a significant, measurable improvement in rib asymmetry. There is no significant difference in improvement between the groups. Thus, a rib resection to improve cosmesis may not be necessary when correcting a primary thoracic curve with advanced instrumentation.
| Results: Table 1 (Clements et al) | ||||
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Thoracic curve (°) Mean/Standard Deviation |
Thoracic scoliometer measurement (°) Mean/Standard Deviation |
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Pre-op
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Post-op
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Pre-op
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Post-op
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| Open ASF (N=24) | 50/4.89 | 21/12.07 | 12/4.65 | 5/4.03 |
| Thoracoscopic ASF (N=21) | 51/7.94 | 23/5.98 | 14/3.48 | 7/3.31 |
| Posterior with rib resection (N=8) | 55/6.93 | 24/14.88 | 16/6.61 | 8/4.91 |
| Posterior without rib resection (N=14) | 52/9.83 | 19/9.62 | 13/3.70 | 6/4.74 |
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