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Comparison of Concave Rib Osteotomies Versus Anterior Release for Correction of Thoracic Adolescent Idiopathic Scoli

Introduction. Concave ribs are positioned to act as a buttress to prevent medial migration of the spine towards the midline. Concave rib osteotomies increase flexibility of rigid curves avoiding the need to anterior release. Overlapping the ostetomised ribs over the concave rod, the shape of the

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Comparison of Concave Rib Osteotomies Versus Anterior Release for Correction of Thoracic Adolescent Idiopathic Scoli

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    1. Comparison of Concave Rib Osteotomies Versus Anterior Release for Correction of Thoracic Adolescent Idiopathic Scoliosis. A Radiographic Analysis. Dr. N. Ventura, Dra. A. Ey, Dr. J. Conill

    2. Introduction Concave ribs are positioned to act as a buttress to prevent medial migration of the spine towards the midline. Concave rib osteotomies increase flexibility of rigid curves avoiding the need to anterior release. Overlapping the ostetomised ribs over the concave rod, the shape of the chest sharply improved

    3. Purpose To compare the radiographic results of concave ribs osteotomies versus anterior release plus posterior instrumentation of scoliosis in young patients The radiographic degrees of thoracic scoliosis using the Cobb method were used to calculate : Percent flexibility : % F: preoperative standing anteroposterior (AP) – preoperative standing bend (AP)/ preoperative standing AP X100 Percent scoliosis correction : %S : preoperative standing anteroposterior (AP) – postopetaive standing (AP) / preoperative standing APX100 Percent bend- correction %B: postoperative standing AP / preoperative standing bend X100

    4. Materials and Methods 39 patients treated surgically by hybrid posterior instrumentation and segmental concave ribs osteotomies (Group I) are compared to 11 patients treated by an anterior release, posterior instrumentation and concave ribs osteotomies ( Group II) and with 15 patients treated by anterior release (open thoracotomy or VATS) and posterior instrumentation without ribs osteotomies (Group III)

    5. Results. Group I: Preoperative curve degree : 112º-53º (80º), postoperative curve degree :64º-20º (35º) ,% F :1 % - 48% (24,8%), S% : 25%-77 % (55%), % B: 30%-100 % (58%) Group II : Preoperative curve 115º-83º (98º), postoperative curve degree 65º -20º (38º), % F : 2%- 41% (14%), % S :43%-76% (60%), % B : 32%-70% (47%). Group III : Preoperative curve degree: 95º-57º (80º), postoperative curve degree :50º -17º (32º), % F :3%-47% (23%), % S: 28%- 77% (60 %), % B: 38%- 77% (51,8%).

    8. Results. There were no neurological complications there were four pulmonary complications ( pleural effusion) who required suction drainage

    9. Conclusions Similar results were achieved between all groups but assuming that in group II curves were greater and less flexible preoperatively, concave ribs osteotomies improved the final results. Although the numbers are small, these data support the hypothesis that addition of multiple concave osteotomies in cases of rigid thoracic curves achieve a similar postoperative correction to anterior release and in very severe curves

    10. References Andriacchi T P, et al. A model for studies of forces in the human spine. J Biomech 7: 497-508,1974 Halsall A P, et al. An experimental evaluation of spinal flexibility with respect to scoliosis surgery. Spine 8: 482-488,1983 Mann D C, et al. Evaluation of the role of concave rib osteotomies in the correction of thoracic scoliosis. Spine 14:491-95,1989

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