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Does an Internal Thoracoplasty Prevent a Reassertion of Back Shape Deformity Following Spine Surgery for Adolescent Idiopathic Thoracic Scoliosis (AIS)?
Objective: To evaluate the effect of surgical treatment on posterior transverse back asymmetry and the rib hump in 137 patients with an adolescent idiopathic thoracic scoliosis (Lenke Type 1).
Methods: The Integrated Shape Imaging System (ISIS) with an additional digital programme was used before and after surgery and for a minimum of 2 years to assess the angle of thoracic inclination (ATI). This represents the balance in the transverse plane between the angle of rib hump elevation (ARHE) on the convexity and the angle of rib depression (ARD)on the concavity as well as the rib hump height.
Results: Posterior only spine surgery with a hybrid AO USS construct (97 patients) had no beneficial effect on improving he ATI and reducing the size of the rib hump in 72%. A reassertion of the rib hump occurred in 24% and became more severe than it was prior to surgery in 22%. However, posterior spine surgery when combined with a first stage anterior spine release and internal thoracoplasty (37 patients) was effective in 92% of not only achieving greater Cobb correction in severe curves of over 80 degrees but also improving the ATI and preventing a later reassertion of the rib hump deformity.
Conclusion: An anterior spine release and internal thoracoplasty has a role in treating large curves with severe back shape deformity in AIS.
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