Tactics for Surgical Treatment of the Double Thoracic Scoliosis: Significance of T1 tilt, first rib elevation and correction ratio / 대한척추외과학회지

ABSTRACT

STUDY DESIGN: A retrospective clinical and radiographic review. OBJECTIVES: The purpose of this study is to suggest the indications and more ideal objective amount of corrections of for upper and lower curves. SUMMARY OF LITERATURE REVIEW There are many controversies exist about the diagnosis and treatment of double thoracic scoliosis yet. MATERIALS AND METHODS: Thirty-nine double thoracic scoliosis patients with left shoulder elevation and/or positive T1 tilt and an upper curve of 25 degrees or more were divided into two groups. Group I (24 patients) underwent fusion on both curves, and Group II (15 patients), on the lower curve alone. Cobb angles, T1 tilt, left first rib elevation (represents trapezial prominence), and shoulder level difference were measured from standing on pre- and post-operative standing films. The correction ratio [Upper curve correction(%)/Lower curve correction(%)] was used to represent describe how much the upper curve was had been corrected compared to versus the lower curve. RESULTS: T1 tilt did not correlate well with left shoulder elevation, but correlated with left first rib elevation. In Group I, T1 tilt and left first rib elevation improved significantly after fusion of the upper curve, whereas these were aggravated in Group II. In Group I, most of the patients with the a correction ratio of more than 0.8, showed balanced shoulder levels finally. CONCLUSIONS: In double thoracic scoliosis patients, T1 tilt and left first rib elevation should be considered in addition to not only left shoulder elevation and the rigidity of upper curve, but also the T1 tilt and left first rib elevation should be considered as the indication of the extension of fusion to upper curve. The amount of upper curve correction should be more than at least 80% of that of the lower curve for a balanced correction in the treatment of double thoracic scoliosis.