Rib Resection in the Treatment of Scoliosis

Flinchum, D

doi:10.1097/00007611-196312000-00008

Cited by 16 publications

(8 citation statements)

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“…Congenital kyphoscoliosis is by its nature a rigid deformity that often requires spinal osteotomy to attain the necessary flexibility to restore the balance of the spinal column in modern times [2,8]. There have been reports about many types of spinal osteotomies and perhaps as many, if not more, reports on the modifications of these techniques in the treatment of congenital kyphoscoliosis [2,3,7,[10][11][12][13][14]16,18,25].…”

Section: Discussionmentioning

confidence: 99%

“…The concept of concave rib osteotomy was introduced by Flinchum [18] in 1963. It should be considered as a release procedure in which the tether of the ribcage on the spine on the concave side is divided, and the flexibility of the scoliotic curve is thus increased.…”

Section: Discussionmentioning

confidence: 99%

“…Multiple chevron osteotomies combined with concave rib osteotomies and posterior pedicle screw instrumentation have been reported to be effective in the treatment of neglected severe idiopathic curves [18][19][20][21][22]. When combined with posterior pedicle screw instrumentation, this technique can provide flexibility in rigid curves and a significant amount of correction.…”

Section: Introductionmentioning

confidence: 99%

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Posterior all-pedicle screw instrumentation combined with multiple chevron and concave rib osteotomies in the treatment of adolescent congenital kyphoscoliosis

et al. 2014

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Posterior all-pedicle screw instrumentation combined with multiple chevron and concave rib osteotomies in the treatment of adolescent congenital kyphoscoliosis

et al. 2014

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“…Rib resection or costodesis on the concavity or the convexity of scoliotic curves has previously been used by several authors either in isolation or in combination with other therapeutic measures [4,8,12,13,17]. However, the results of these clinical trials in patients of different age and with curves of varying aetiology, degree and pattern have been largely disappointing and the approaches consequently abandoned.…”

Section: Discussionmentioning

confidence: 99%

A physiological approach to surgical treatment of progressive early idiopathic scoliosis

Xiong

Sevastik

1998

European Spine Journal

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IntroductionThe results of previous studies have shown that in girls with right convex thoracic adolescent idiopathic scoliosis (IS) there is significantly increased vascularity of the left breast as compared with the right one [10]. It has also been found that in deceased women with right convex thoracic IS, the mean length of the ribs corresponding to the apical and the two periapical vertebrae was greater on the concave than on the convex side [11]. These changes were ascribed to disturbed sympathetic function. Indeed, in growing rabbits stimulation of the longitudinal rib growth by unilateral resection of intercostal nerves, including the sympathetic fibres, resulted in hyperaemia of the denervated anterior hemithorax [1], increased longitudinal rib growth [2] and scoliosis with the convexity to the opposite side of the denervation and characteristics of IS in humans [3].The inter-related results of these and other clinical and experimental studies have provided evidence supporting the thoracospinal theory of the pathogenesis of IS. According to this new theory, stimulation of longitudinal growth of the left ribs is the origin of right convex IS in adolescent girls [15].In connection with these studies, experiments were also undertaken to investigate the possibility of correcting or suppressing the progression of scoliosis induced in rabbits.In a first experiment, scoliosis was induced by unilateral resection of three intercostal nerves on the left side in growing rabbits. Three months after the operation, all rabbits had developed scoliosis with a mean Cobb angle of 22.5°. The concavity of the curve was on the side of the denervation. At this time, one rib of the convexity, one, two, three or four spaces above the apical vertebra of the curve, after osteotomy, was mechanically elongated by 7 mm using a metallic expander. The initial scoliosis was corrected immediately after the operation, and remained unchanged 3 weeks later [14] (Fig. 1).In a second experiment, three intercostal nerves were resected on one side of the thorax in rabbits with a mean body weight of 350 g. Then the animals were allocated into three groups, with six rabbits in each. In the first group, used as reference, a progressive scoliosis developed in all animals, which 3 months after the operation averaged 27.0°. In the second group, group A, 1 month af- AbstractThe results of previous clinical and experimental studies have provided accumulated evidence for the role of rib asymmetry in the pathogenesis of idiopathic scoliosis (IS). Moreover, it has been shown that scoliosis induced in rabbits can be corrected by elongation or growth stimulation of ribs on the side of the convexity. Taking these observations into consideration, a 7-year-old girl with right convex thoracolumbar IS was operated upon by 2-cm shortening of three concave ribs. The preoperative coronal Cobb angle was 46°and the sagittal angle was 55°. Twenty-seven months after the operation the curves were reduced to 21°a nd 35°, or by 54 and 36%, respectively. It is concluded ...

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“…The rib cage deformity is sometimes treated by direct costoplasty and rib resection (14,29,32), but it is not clear how these procedures alter the geometry of the rib cage. Moreover, it has been suggested that an asymmetric rib cage may initiate scoliosis (20,23,27,28,30,31).…”

mentioning

confidence: 99%

Rib cage deformities in scoliosis: Spine morphology, rib cage stiffness, and tomography imaging

Closkey

Schultz

1993

Journal Orthopaedic Research

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A computer-implemented biomechanical model of a thoracolumbar spine and deformable rib cage was used to investigate the influence of spine morphology and rib cage stiffness properties on the rib cage deformities that arise from scoliosis and to study the relationship of actual rib distortions with those seen on computed tomography (CT) scans. For the purposes of this study, it was assumed that rib cage deformities result from forces imposed on the ribs by the deforming spine. When a structurally normal rib cage was allowed to follow freely the imposition of scoliotic curves on the spine, different configurations of scoliosis led to substantial differences in the resulting rib cage deformities. Rib cage lateral offset correlated well with the Cobb angle of the scoliosis but not with the apical vertebral axial rotation, whereas rib cage axial rotation correlated well with apical vertebral axial rotation but not with the Cobb angle. These model-obtained findings mirror clinical findings that correction of the Cobb angle leads to correction of the lateral offset of the rib cage but does not correlate well with correction of the rib cage axial rotation. The stiffnesses of the ligamentous tissue connecting the sternum to the pelvis, of the costovertebral joints, and of the ribs themselves also influenced the rib deformities substantially. The influence of the sternopelvic ligamentous ties has not been recognized previously. The total rib cage volume remained essentially constant regardless of the severity of the resulting deformity, but the distribution of this volume between convex and concave sides varied somewhat.(ABSTRACT TRUNCATED AT 250 WORDS)

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Rib Resection in the Treatment of Scoliosis

Cited by 16 publications

References 0 publications

Posterior all-pedicle screw instrumentation combined with multiple chevron and concave rib osteotomies in the treatment of adolescent congenital kyphoscoliosis

Posterior all-pedicle screw instrumentation combined with multiple chevron and concave rib osteotomies in the treatment of adolescent congenital kyphoscoliosis

A physiological approach to surgical treatment of progressive early idiopathic scoliosis

Rib cage deformities in scoliosis: Spine morphology, rib cage stiffness, and tomography imaging

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