Skip to main content

Advertisement

SpringerLink
Log in

Recurrence of rib prominence following surgery for adolescent idiopathic scoliosis with pedicle screws and direct vertebral body derotation

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

Pedicle screw constructs combined with direct vertebral body derotation (DVBD) provide a powerful corrective force of the rib prominence associated with adolescent idiopathic scoliosis (AIS). We wished to evaluate the incidence and correlative factors associated with recurrence of rib prominence (RRP) developing postoperatively despite adequate initial correction.

Methods

103 patients with AIS underwent pedicle screw fixation with DVBD without thoracoplasty and had postoperative scoliometer readings at 6, 12, and 24 months. Patients with RRP, defined as a postoperative scoliometer increase ≥5°, were compared to those without recurrence.

Results

The mean rib prominence measured 14.0 ± 4.3° preoperatively, with a correction of 50.3 ± 26.7 % at 6 months, 49.0 ± 39.0 % at 1 year, and 49.1 ± 26.7 % at 2 years. RRP was identified in 15.5 % of the patients with a correction of 57.5 ± 25.5 % at 6 months, 47.2 ± 42.5 % at 1 year, and 40.4 ± 21.6 % at 2 years. At 2 years, the RRP group demonstrated a significantly larger major coronal Cobb (p < 0.05) and a trend towards less curve correction (p = 0.09). Patients with open triradiates had a significantly higher rate of RRP compared to those with closed (p = 0.01). Worsening apical vertebral rotation at 2 years post-operation occurred in 43.8 % (7/16) of the patients with RRP.

Conclusion

RRP after posterior fusion for AIS with all pedicle screw constructs and DVBD occurred in 15.5 % of patients in our study. Patients with open triradiate cartilage had a significantly higher rate of RRP, although most with RRP were skeletally mature. There was a trend towards loss of coronal correction and increased apical vertebral rotation at 2 years in patients with RRP. The potential for RRP after adequate initial correction should be discussed with patients.

Level of evidence

2.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Erkula G, Sponseller PD, Kiter AE (2003) Rib deformity in scoliosis. Eur Spine J 12(3):281–287

    PubMed Central  PubMed  Google Scholar 

  2. Sanders JO, Harrast JJ, Kuklo TR, Polly DW, Bridwell KH, Diab M, Dormans JP, Drummond DS, Emans JB, Johnston CE 2nd, Lenke LG, McCarthy RE, Newton PO, Richards BS, Sucato DJ (2007) The Spinal Appearance Questionnaire: results of reliability, validity, and responsiveness testing in patients with idiopathic scoliosis. Spine (Phila Pa 1976) 32(24):2719–2722

    Article  Google Scholar 

  3. Geissele AE, Ogilvie JW, Cohen M, Bradford DS (1994) Thoracoplasty for the treatment of rib prominence in thoracic scoliosis. Spine (Phila Pa 1976) 19(14):1636–1642

    Article  CAS  Google Scholar 

  4. Min K, Waelchli B, Hahn F (2005) Primary thoracoplasty and pedicle screw instrumentation in thoracic idiopathic scoliosis. Eur Spine J 14(8):777–782

    Article  PubMed Central  PubMed  Google Scholar 

  5. Soultanis K, Pyrovolou N, Karamitros A, Konstantinou V, Lenti A, Soucacos PN (2006) The use of thoracoplasty in the surgical treatment of idiopathic scoliosis. Stud Health Technol Inform 123:327–333

    CAS  PubMed  Google Scholar 

  6. Shufflebarger HL, Smiley K, Roth HJ (1994) Internal thoracoplasty. A new procedure. Spine (Phila Pa 1976) 19(7):840–842

    Article  CAS  Google Scholar 

  7. Steel HH (1983) Rib resection and spine fusion in correction of convex deformity in scoliosis. J Bone Joint Surg Am 65(7):920–925

    CAS  PubMed  Google Scholar 

  8. Suk SI, Kim JH, Kim SS, Lee JJ, Han YT (2008) Thoracoplasty in thoracic adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 33(10):1061–1067

    Article  Google Scholar 

  9. Samdani AF, Hwang SW, Miyanji F, Lonner B, Marks MC, Sponseller PD, Newton PO, Cahill PJ, Shufflebarger HL, Betz RR (2012) Direct vertebral body derotation, thoracoplasty, or both: which is better with respect to inclinometer and SRS-22 scores? Spine (Phila Pa 1976) 37(14):E849–E853

    Article  Google Scholar 

  10. Yaszay B, Jazayeri R, Lonner B (2009) The effect of surgical approaches on pulmonary function in adolescent idiopathic scoliosis. J Spinal Disord Tech 22(4):278–283

    Article  PubMed  Google Scholar 

  11. Kim YJ, Lenke LG, Bridwell KH, Kim KL, Steger-May K (2005) Pulmonary function in adolescent idiopathic scoliosis relative to the surgical procedure. J Bone Joint Surg Am 87(7):1534–1541

    Article  PubMed  Google Scholar 

  12. Winter RB (2002) Flail chest secondary to excessive rib resection in idiopathic scoliosis: case report. Spine (Phila Pa 1976) 27(6):668–670

    Article  Google Scholar 

  13. Lee SM, Suk SI, Chung ER (2004) Direct vertebral rotation: a new technique of three-dimensional deformity correction with segmental pedicle screw fixation in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 29(3):343–349

    Article  Google Scholar 

  14. Asghar J, Samdani AF, Pahys JM, D’Andrea LP, Guille JT, Clements DH, Betz RR, Harms Study Group (2009) Computed tomography evaluation of rotation correction in adolescent idiopathic scoliosis: a comparison of an all pedicle screw construct vs. a hook-rod system. Spine (Phila Pa 1976) 34(8):804–807

    Article  Google Scholar 

  15. Kadoury S, Cheriet F, Beausejour M, Stokes IA, Parent S, Labelle H (2009) A three-dimensional retrospective analysis of the evolution of spinal instrumentation for the correction of adolescent idiopathic scoliosis. Eur Spine J 18(1):23–37

    Article  PubMed Central  PubMed  Google Scholar 

  16. Hwang SW, Samdani AF, Lonner B, Miyanji F, Stanton P, Marks MC, Bastrom T, Newton PO, Betz RR, Cahill PJ (2012) Impact of direct vertebral body derotation on rib prominence: are preoperative factors predictive of changes in rib prominence? Spine (Phila Pa 1976) 37(2):E86–E89. doi:10.1097/BRS.0b013e31821fd379

    Article  Google Scholar 

  17. Upasani VV, Chambers RC, Dalal AH, Shah SA, Lehman RA Jr, Newton PO (2009) Grading apical vertebral rotation without a computed tomography scan: a clinically relevant system based on the radiographic appearance of bilateral pedicle screws. Spine (Phila Pa 1976) 34(17):1855. doi:10.1097/BRS.0b013e3181abf797

    Article  Google Scholar 

  18. Cote P, Kreitz BG, Cassidy JD, Dzus AK, Martel J (1998) A study of the diagnostic accuracy and reliability of the Scoliometer and Adam’s forward bend test. Spine (Phila Pa 1976) 23(7):796–802 (discussion 803)

    Article  CAS  Google Scholar 

  19. Hwang SW, Samdani AF, Cahill PJ (2012) The impact of segmental and en bloc derotation maneuvers on scoliosis correction and rib prominence in adolescent idiopathic scoliosis. J Neurosurg Spine 16(4):345–350. doi:10.3171/2011.11.SPINE11277

    Article  PubMed  Google Scholar 

  20. DiSilvestre M, Lolli F, Bakaloudis G, Maredi E, Vommaro F, Pastorelli F (2012) Apical vertebral derotation in the posterior treatment of adolescent idiopathic scoliosis: myth or reality? Eur Spine J 22(2):313–323

    Article  Google Scholar 

  21. Gitelman Y, Lenke LG, Bridwell KH, Auerbach JD, Sides BA (2011) Pulmonary function in adolescent idiopathic scoliosis relative to the surgical procedure: a 10-year follow-up analysis. Spine (Phila Pa 1976) 36(20):1665–1672

    Article  Google Scholar 

  22. Dubousset J, Herring JA, Shufflebarger HL (1989) The crankshaft phenomenon. J Pediatr Orthop 9(5):541–550

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

This study was supported by a research grant from DePuy Synthes Spine to the Setting Scoliosis Straight Foundation for the Harms Study Group.

IRB statement

IRB approval for the study was obtained locally from each contributing institution’s review board, and consent was obtained from each patient prior to data collection.

Author information

Authors and Affiliations

  1. Shriners Hospitals for Children, 3551 N Broad Street, Philadelphia, PA, 19140, USA

    Amer F. Samdani, James T. Bennett & Jane S. Hoashi

  2. Miami Children’s Hospital, Miami, FL, USA

    Jahangir Asghar

  3. British Columbia Children’s Hospital, Vancouver, BC, Canada

    Firoz Miyanji

  4. NYU Hospital for Joint Diseases, New York, NY, USA

    Baron S. Lonner

  5. Rady Children’s Hospital, San Diego, CA, USA

    Michelle C. Marks & Peter O. Newton

  6. Institute for Spine & Scoliosis, Lawrenceville, NJ, USA

    Randal R. Betz

Authors
  1. Amer F. Samdani
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jahangir Asghar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Firoz Miyanji
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. James T. Bennett
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jane S. Hoashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Baron S. Lonner
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Michelle C. Marks
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Peter O. Newton
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Randal R. Betz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Amer F. Samdani.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Samdani, A.F., Asghar, J., Miyanji, F. et al. Recurrence of rib prominence following surgery for adolescent idiopathic scoliosis with pedicle screws and direct vertebral body derotation. Eur Spine J 24, 1547–1554 (2015). https://doi.org/10.1007/s00586-014-3716-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-014-3716-x

Keywords

Search

Navigation