Why Is There Always a Remnant Rib Hump Deformity after Spinal Operations in Idiopathic Scoliosis: Aetiological Implications and Recognition of the Proper Rib Level for Costoplasty
The aim of this report is to review the literature dealing with the postoperative correction of rib hump (RH) after spinal operations for adolescent idiopathic scoliosis (AIS) and its aetiological implications of hump postoperative fate for IS. Recommendations related to RH deformity for the follow-...
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MDPI AG
2023-10-01
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| Series: | Children |
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| Online Access: | https://www.mdpi.com/2227-9067/10/10/1697 |
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| author | Theodoros B. Grivas Elias Vasiliadis George Vynichakis Michail Chandrinos Konstantinos Athanasopoulos Paschalis Christodoulides |
| author_facet | Theodoros B. Grivas Elias Vasiliadis George Vynichakis Michail Chandrinos Konstantinos Athanasopoulos Paschalis Christodoulides |
| author_sort | Theodoros B. Grivas |
| collection | DOAJ |
| description | The aim of this report is to review the literature dealing with the postoperative correction of rib hump (RH) after spinal operations for adolescent idiopathic scoliosis (AIS) and its aetiological implications of hump postoperative fate for IS. Recommendations related to RH deformity for the follow-up of younger asymmetric but not scoliotic children are provided, and the concept that clinical monitoring of the chest deformity is more important than merely an initially negative radiographic examination (curve less than 10°) is underlined. Additionally, guidelines are provided based on the segments T1–T12 rib index (RI) in the existing lateral preoperative radiographs for the optimal selection of the rib level for a successfully costoplasty. This review is based on the collected articles that used either the RI method, derived from the double rib contour sign (DRCS) at the lateral spinal radiographs, or alternative methods for the assessment of the RH deformity and presented the results of the operative treatment of the scoliotic spine on RH. A total of 19 relevant articles published from 1976 to 2022 were found in PubMed. Findings: All the above articles show that not only is the hump incompletely corrected, but it recurs and worsens during the follow-up and even more intensively in skeletally immature operated scoliosis children. Conclusions and Future Directions: Surgery straightens the spine, yet the RH is corrected approximately only as much as the spinal derotation. The only way to correct the RH more is with costoplasty, which, however, is not performed in most cases for many reasons. The key reason for this phenomenon is the fact that the RH deformity (RHD) is mainly due to the asymmetric development of the ribs and much less so due to the rotation of the vertebrae in the thoracic spine. Surgery on the spine cannot limit the asymmetry of the ribs or stop the mechanism that causes their asymmetrical growth. The results presented in all the reviewed articles support the important protagonistic role of RHD on scoliogenesis, which precedes the subsequent formed spinal deformity. |
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| id | doaj.art-7f331cbd969141cfbcf982dede11bd5e |
| institution | Directory Open Access Journal |
| issn | 2227-9067 |
| language | English |
| last_indexed | 2024-03-10T21:20:43Z |
| publishDate | 2023-10-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Children |
| spelling | doaj.art-7f331cbd969141cfbcf982dede11bd5e2023-11-19T16:05:47ZengMDPI AGChildren2227-90672023-10-011010169710.3390/children10101697Why Is There Always a Remnant Rib Hump Deformity after Spinal Operations in Idiopathic Scoliosis: Aetiological Implications and Recognition of the Proper Rib Level for CostoplastyTheodoros B. Grivas0Elias Vasiliadis1George Vynichakis2Michail Chandrinos3Konstantinos Athanasopoulos4Paschalis Christodoulides5Department of Orthopedics & Traumatology, “Tzaneio” General Hospital of Piraeus, 18536 Piraeus, Greece3rd Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, KAT Hospital, 16541 Athens, GreeceOrthopedic Department, Gen. Hospital of Argolida—N.M. Argos, 21231 Argos, GreeceOrthopedic Department, Gen. Hospital of Argolida—N.M. Argos, 21231 Argos, GreeceOrthopedic Department, Peristeri Medical Group, 12132 Peristeri, GreeceDepartment of Radiology, General Hospital of Paphos, Paphos 8026, CyprusThe aim of this report is to review the literature dealing with the postoperative correction of rib hump (RH) after spinal operations for adolescent idiopathic scoliosis (AIS) and its aetiological implications of hump postoperative fate for IS. Recommendations related to RH deformity for the follow-up of younger asymmetric but not scoliotic children are provided, and the concept that clinical monitoring of the chest deformity is more important than merely an initially negative radiographic examination (curve less than 10°) is underlined. Additionally, guidelines are provided based on the segments T1–T12 rib index (RI) in the existing lateral preoperative radiographs for the optimal selection of the rib level for a successfully costoplasty. This review is based on the collected articles that used either the RI method, derived from the double rib contour sign (DRCS) at the lateral spinal radiographs, or alternative methods for the assessment of the RH deformity and presented the results of the operative treatment of the scoliotic spine on RH. A total of 19 relevant articles published from 1976 to 2022 were found in PubMed. Findings: All the above articles show that not only is the hump incompletely corrected, but it recurs and worsens during the follow-up and even more intensively in skeletally immature operated scoliosis children. Conclusions and Future Directions: Surgery straightens the spine, yet the RH is corrected approximately only as much as the spinal derotation. The only way to correct the RH more is with costoplasty, which, however, is not performed in most cases for many reasons. The key reason for this phenomenon is the fact that the RH deformity (RHD) is mainly due to the asymmetric development of the ribs and much less so due to the rotation of the vertebrae in the thoracic spine. Surgery on the spine cannot limit the asymmetry of the ribs or stop the mechanism that causes their asymmetrical growth. The results presented in all the reviewed articles support the important protagonistic role of RHD on scoliogenesis, which precedes the subsequent formed spinal deformity.https://www.mdpi.com/2227-9067/10/10/1697idiopathic scoliosisrib humprib cage deformityaetiologyrib indexsegmental rib index |
| spellingShingle | Theodoros B. Grivas Elias Vasiliadis George Vynichakis Michail Chandrinos Konstantinos Athanasopoulos Paschalis Christodoulides Why Is There Always a Remnant Rib Hump Deformity after Spinal Operations in Idiopathic Scoliosis: Aetiological Implications and Recognition of the Proper Rib Level for Costoplasty Children idiopathic scoliosis rib hump rib cage deformity aetiology rib index segmental rib index |
| title | Why Is There Always a Remnant Rib Hump Deformity after Spinal Operations in Idiopathic Scoliosis: Aetiological Implications and Recognition of the Proper Rib Level for Costoplasty |
| title_full | Why Is There Always a Remnant Rib Hump Deformity after Spinal Operations in Idiopathic Scoliosis: Aetiological Implications and Recognition of the Proper Rib Level for Costoplasty |
| title_fullStr | Why Is There Always a Remnant Rib Hump Deformity after Spinal Operations in Idiopathic Scoliosis: Aetiological Implications and Recognition of the Proper Rib Level for Costoplasty |
| title_full_unstemmed | Why Is There Always a Remnant Rib Hump Deformity after Spinal Operations in Idiopathic Scoliosis: Aetiological Implications and Recognition of the Proper Rib Level for Costoplasty |
| title_short | Why Is There Always a Remnant Rib Hump Deformity after Spinal Operations in Idiopathic Scoliosis: Aetiological Implications and Recognition of the Proper Rib Level for Costoplasty |
| title_sort | why is there always a remnant rib hump deformity after spinal operations in idiopathic scoliosis aetiological implications and recognition of the proper rib level for costoplasty |
| topic | idiopathic scoliosis rib hump rib cage deformity aetiology rib index segmental rib index |
| url | https://www.mdpi.com/2227-9067/10/10/1697 |
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