Skip to main content

Bilateral reconstructive costoplasty for razorback deformity correction in adolescent idiopathic scoliosis



Correcting the chest wall deformity is an important goal of scoliosis surgery. A prominent rib hump deformity may not be adequately addressed by scoliosis correction alone. It has been shown that costoplasty in conjugation with scoliosis correction and instrumented spinal fusion is superior to spinal fusion alone in addressing the chest wall deformity. In cases of severe rib hump deformity unilateral convex side costoplasty alone might not adequately restore thoracic cage symmetry necessitating for additional concave side rib cage reconstruction.

Case report

A 16-year-old male with adolescent idiopathic scoliosis and a sharp, cosmetically unacceptable, prominent rib hump (razorback deformity) underwent scoliosis correction with posterior spinal fusion and bilateral costoplasty. The convex-sided ribs were resected and used for concave-sided rib reconstruction. The rib hump height was reduced from 70 mm before the procedure to 10 mm after the procedure and the apical trunk rotation was reduced from 36° to 5°, respectively. Solid spinal fusion and ribs union was achieved. The patient remained very satisfied with no loss of correction at 2-year postoperative follow-up.


Bilateral costoplasty in conjugation with scoliosis correction may provide a safe and effective method for the treatment of severe rib cage deformities associated with thoracic scoliosis. It should be considered in the presence of prominent rib hump deformity, where scoliosis correction alone or with unilateral costoplasty is unlikely to provide adequate correction.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6


  1. Bridwell KH (1999) Surgical treatment of idiopathic adolescent scoliosis. Spine 24:2607

    CAS  PubMed  Article  Google Scholar 

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

    PubMed Central  PubMed  Google Scholar 

  3. Thulbourne T, Gillespie R (1976) The rib hump in idiopathic scoliosis. Measurement, analysis and response to treatment. J Bone Joint Surg Br 58:64–71

    CAS  PubMed  Google Scholar 

  4. Lonstein JE, Winter RB, Moe JH, Bianco AJ, Campbell RG, Norval MA (1976) School screening for the early detection of spine deformities. Progress and pitfalls. Minn Med 59:51

    CAS  PubMed  Google Scholar 

  5. Karachalios T, Sofianos J, Roidis N, Sapkas G, Korres D, Nikolopoulos K (1999) Ten-year follow-up evaluation of a school screening program for scoliosis: Is the forward-bending test an accurate diagnostic criterion for the screening of scoliosis? Spine 24:2318

    CAS  PubMed  Article  Google Scholar 

  6. Clayson D, Levine DB (1976) Adolescent scoliosis patients: personality patterns and effects of corrective surgery. Clin Orthop Relat Res 116:99–102

    PubMed  Google Scholar 

  7. Lonstein JE (2006) Scoliosis: surgical versus nonsurgical treatment. Clin Orthop Relat Res 443:248–259

    PubMed  Article  Google Scholar 

  8. Gurkan E, Paul DS (2003) Rib deformity in scoliosis. Eur Spine J 12:281–287

    Google Scholar 

  9. Chang MS, Lenke LG (2009) Vertebral derotation in adolescent idiopathic scoliosis. Oper Tech Orthop 19:19–23

    Article  Google Scholar 

  10. Vallespir GP, Flores JB, Trigueros IS, Sierra EH, Fernández PD, Olaverri JCR, Alonso MG, Galea RR, Francisco AP, de Paz BR (2008) Vertebral coplanar alignment: a standardized technique for three dimensional correction in scoliosis surgery: technical description and preliminary results in Lenke type 1 curves. Spine 33:1588–1597

    PubMed  Article  Google Scholar 

  11. Mattila M, Jalanko T, Helenius I (2013) En bloc vertebral column derotation provides spinal derotation but no additional effect on thoracic rib hump correction as compared with no derotation in adolescents undergoing surgery for idiopathic scoliosis with total pedicle screw instrumentation. Spine 38:1576–1583

    PubMed  Article  Google Scholar 

  12. Di Silvestre M, Lolli F, Bakaloudis G, Maredi E, Vommaro F, Pastorelli F (2013) Apical vertebral derotation in the posterior treatment of adolescent idiopathic scoliosis: myth or reality? Eur Spine J 22:313–323

    PubMed Central  PubMed  Article  Google Scholar 

  13. Rushton PRP, Grevitt MP (2014) Do vertebral derotation techniques offer better outcomes compared to traditional methods in the surgical treatment of adolescent idiopathic scoliosis? Eur Spine J 23:1166–1176. doi:10.1007/s00586-014-3242-x

    PubMed  Article  Google Scholar 

  14. Kadoury S, Cheriet F, Beauséjour 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 18:23–37

    PubMed Central  PubMed  Article  Google Scholar 

  15. Briard J, Chopin D, Cauchoix J (1980) Surgical correction of rib deformity in scoliosis. Orthop Trans 4:25

    Google Scholar 

  16. Manning C, Prime F, Zorab P (1973) Partial costectomy as a cosmetic operation in scoliosis. J Bone Joint Surg Br 55:521–527

    CAS  PubMed  Google Scholar 

  17. Laughlin T, Mohlenbrock W (1980) Rib hump resection in scoliosis surgery. Orthop Trans 4:24–25

    Google Scholar 

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

    CAS  PubMed  Google Scholar 

  19. Broome G, Simpson A, Catalan J, Jefferson R, Houghton G (1990) The modified Schollner costoplasty. J Bone Joint Surg Br 72:894–900

    CAS  PubMed  Google Scholar 

  20. Barrett D, MacLean J, Bettany J, Ransford A, Edgar M (1993) Costoplasty in adolescent idiopathic scoliosis. Objective results in 55 patients. J Bone Joint Surg Br 75:881–885

    CAS  PubMed  Google Scholar 

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

    PubMed Central  PubMed  Article  Google Scholar 

  22. Metz-Stavenhagen P, Hildebrand R, Hempfing A, Ferraris L, Meier O, Krebs S (2008) Concave thoracoplasty (CTP) and posterior instrumentation for correction of rigid thoracic scoliosis: results at five to seven years. J Bone Joint Surg Br 90:441

    Google Scholar 

  23. Yang JH, Bhandarkar AW, Kasat NS, Suh SW, Hong JY, Modi HN, Hwang JH (2013) Isolated percutaneous thoracoplasty procedure for skeletally mature adolescent idiopathic scoliosis patients, with rib deformity as their only concern: short-term outcomes. Spine 38:37–43

    PubMed  Article  Google Scholar 

  24. Harding IJ, Chopin D, Charosky S, Vialle R, Carrizo D, Delecourt C (2005) Long-term results of Schollner costoplasty in patients with idiopathic scoliosis. Spine 30:1627–1631

    PubMed  Article  Google Scholar 

  25. Min K, Sdzuy C, Farshad M (2013) Posterior correction of thoracic adolescent idiopathic scoliosis with pedicle screw instrumentation: results of 48 patients with minimal 10-year follow-up. Eur Spine J 22:345–354

    PubMed Central  PubMed  Article  Google Scholar 

  26. de Kleuver M, Lewis SJ, Germscheid NM, Kamper SJ, Alanay A, Berven SH, Cheung KM, Ito M, Lenke LG, Polly DW (2014) Optimal surgical care for adolescent idiopathic scoliosis: an international consensus. Eur Spine J:1–16. doi:10.1007/s00586-014-3356-1

  27. Aaro S, Dahlborn M (1982) The effect of Harrington instrumentation on the longitudinal axis rotation of the apical vertebra and on the spinal and rib-cage deformity in idiopathic scoliosis studied by computer tomography. Spine 7:456–462

    CAS  PubMed  Article  Google Scholar 

  28. Edgar M, Mehta M (1988) Long-term follow-up of fused and unfused idiopathic scoliosis. J Bone Joint Surg Br 70:712–716

    CAS  PubMed  Google Scholar 

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

    CAS  PubMed  Article  Google Scholar 

  30. Owen R, Turner A, Bamforth J, Taylor J, Jones R (1986) Costectomy as the first stage of surgery for scoliosis. J Bone Joint Surg Br 68:91–95

    CAS  PubMed  Google Scholar 

  31. Chen S-H, Huang T-J, Lee Y-Y, Hsu RW-W (2002) Pulmonary function after thoracoplasty in adolescent idiopathic scoliosis. Clin Orthop Relat Res 399:152–161

    PubMed  Article  Google Scholar 

  32. Srinivas S, Shetty R, Cacciola F, Collins I, Mehdian S (2010) Late costoplasty in idiopathic scoliosis. J Bone Joint Surg Br 92:426

    Google Scholar 

  33. Singhal R, Perry DC, Prasad S, Davidson NT, Bruce CE (2013) The use of routine preoperative magnetic resonance imaging in identifying intraspinal anomalies in patients with idiopathic scoliosis: a 10-year review. Eur Spine J 22:355–359

    PubMed Central  PubMed  Article  Google Scholar 

Download references

Conflict of interest


Author information

Authors and Affiliations


Corresponding author

Correspondence to Bronek Maximilian Boszczyk.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Behrbalk, E., Uri, O., Clamp, J.A. et al. Bilateral reconstructive costoplasty for razorback deformity correction in adolescent idiopathic scoliosis. Eur Spine J 24, 234–241 (2015).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Razorback deformity
  • Rib hump
  • Scoliosis
  • Thoracoplasty
  • Costoplasty
  • Plate
  • Screw