The use of thoracoplasty in the surgical treatment of idiopathic scoliosis.

INTRODUCTION: Rib prominence on the convex side results from vertebral rotation. The cosmetic deformity of the back in scoliosis is only partially corrected by operations on the spine itself, whilst costoplasty addresses the problem directly, and improves the cosmesis. PURPOSE: Our experience in convex and concave side thoracoplasty is discussed. PATIENTS AND METHODS: The selection of the patients for thoracoplasty was done primarily taking into consideration the cosmetic disturbance of the rib hump and the consequences to the psychism of the patient. A total of 35 scoliotic patients (32 females and 3 males) with mean age 18.8 years underwent thoracoplasty in combination with posterior spinal fusion. In 23 patients (3 males and 20 females) convex side thoracoplasty (rib resection at the site of the hump) was done as a first stage procedure (18 patients) or a second stage procedure (5 patients). In the patients with spinal fusion at the same time, the resected ribs were used as bone graft. 12 female patients were treated with concave side thoracoplasty (osteotomies of the medial part of the ribs and elevation of the ribs on the instrumentation rod) as a first stage procedure combined with spinal fusion, while in one 22 female patient both side thoracoplasty was done as a second stage procedure. CONCLUSION: Either form of thoracoplasty was an effective and impressive way to improve the patient's appearance although it was not possible to quantify the results. The complications that were presented viz. 4 haemopneumothorax, 2 pneumothorax, 2 pneumonia) were treated successfully.

Instrumentation loosening and material of implants as predisposal factors for late postoperative infections in operated idiopathic scoliosis.

INTRODUCTION: Instrumentation loosening and metal corrosion are predisposal factors under investigation for late Postoperative infections. PURPOSE OF THE STUDY: To investigate the contribution of the instrumentation material (stainless steel versus titanium implants) and the mechanical loosening in the development of late postoperative spinal infection. PATIENTS AND METHODS: The first group of patients involves 50 idiopathic scoliotic patients who were treated with first generation posterior stainless steel spinal segmental multihook instrumentation. The minimum post operative follow up was 4 years. Five patients presented with late infections 1 to 5 years post operatively. Removal of instrumentation was the effective solution to this problem. Common intraoperative findings were some degree of instrumentation loosening and corrosion. The second group involves 40 idiopathic scoliotic patients who were treated with newer generation posterior titanium spinal segmental multihook-multiscrew instrumentation system. More extensive use of pedicle screws was performed to the second group resulting in a more stable mechanical construct. Follow up ranged from 2 to 5 years. None of those patients presented late postoperative infection or any evidence of instrumentation loosening or failure. CONCLUSION: We believe that newer multihook-multiscrew titanium spinal instrumentation systems have smaller incidence of late postoperative infections because they provide a more stable construct (pedicle screws) with fewer tendencies for micro motion or failure, and they may give the advantage of greater bone adhesion on the implant resulting in the production of thinner biofilm, thus decreasing the chances of infection.