17
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Rib hump deformity assessment using the rib index in adolescent idiopathic scoliotics treated with full screw or hybrid constructs: aetiological implications

      research-article
      1 , 1 , 2 , , 1 , 1 , 1
      Scoliosis
      BioMed Central
      10th International Research Society of Spinal Deformities (IRSSD)
      29 June-2 July 2014

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Background

          Review of literature reveals that in Idiopathic Scoliosis (IS) children, the post-operative rib hump (RH) correction using full transpedicular screw construct has never been compared to hybrid constructs, applying the Rib-Index (RI) method. Therefore the aim of this report is to study which of the above two constructs offers better postoperative Rib Hump Deformity (RHD) correction.

          Methods

          Twenty five patients with Adolescent Idiopathic Scoliosis (AIS) were operated using full pedicle screw construct or hybrid construct. Sixteen underwent full screw instrumentation (group A) and nine an hybrid one (group B). The median age for group A was 15 years and for group B 17.2 years. The RHD was assessed on the lateral spinal radiographs using the RI. The RI was calculated by the ratio of spine distances d1/d2, where d1 is the distance between the most extended point of the most extending rib contour and the posterior margin of the corresponding vertebra on the lateral scoliosis films and d2 is the distance from the least projected rib contour and the posterior margin of the same vertebra. Moreover the amount of RI correction was calculated by subtracting the post-operative RI from the pre-operative RI.

          Results

          Although within group A the RI correction was statistical significant (the pre-op RI was 1.93 and the post-op 1.37; p<0.001) and similarly in group B (the mean pre-op RI was 2.06 while the mean post-op 1.51; p=0.008), between group A and B the post-operative RI correction mean values were found to be no statistically significant, (p=0.803).

          Conclusion

          Although the pre- and post-operative RI correction was statistically significant within each group, this did not happen post-operatively between the two groups. It appears that the RHD correction is not different, no matter what the spinal construct type was used. Provided that the full screw construct is powerful, the post-operative derotation and RHD correction was expected to be better than when an hybrid construct is applied, which is not the case in this study. It is therefore implied that the RHD results more likely from the asymmetric rib growth rather than from vertebral rotation, as it has been widely believed up to now. In 2013 Lykissas et al, reported that costoplasty combined with pedicle screws and vertebral derotation significantly improved RH deformity as opposed to pedicle screws and vertebral derotation alone. Another interesting implication is that the spinal deformity is the result of the thoracic asymmetry, implication in line with the late Prof. John Sevastikoglou’s (Sevastik’s) thoracospinal concept.

          Related collections

          Most cited references3

          • Record: found
          • Abstract: found
          • Article: not found

          The Double Rib Contour Sign (DRCS) in lateral spinal radiographs: aetiologic implications for scoliosis.

          All lateral spinal radiographs in idiopathic scoliosis show a DRC sign of the thoracic cage, a radiographic expression of the rib hump. The outline of the convex overlies the contour of the concave ribs. The aim of this study is to assess this DRC sign in children with and without Late Onset Idiopathic Scoliosis (LOIS) with 10 degrees -20 degrees Cobb angle, and to examine whether in scoliosis the deformity of the thorax or that of the spine develops first. The radiographs of 133 children referred to hospital in a school screening study were examined. There were 47 boys and 86 girls, 13.28 and 13.39 years old respectively. The Cobb angle was measured and the radiological lateral spinal profile (LSP) was appraised from an angle made by a line drawn down the posterior surface of each vertebral body (T1-L5) and by the vertical. The children, boys and girls, were divided in 5 groups, namely: 1) with straight spines, 2) with spinal curvature having a Cobb angle or = 7 degrees), the thorax deformity, in terms of the DRC sign, has already been developed. 70% of these children were scoliotic. The others had a curvature of less than 9 degrees of Cobb angle (10%) or they were children with straight spines (20%) who were followed because of their existing rib hump. The non-scoliotics were 1,5-2 years younger than the ones who had already developed scoliosis, and they had both approximately a "rib index" of 1,5. The DRC sign is present in all referrals. In contrary, there is no scoliotic spine without it, as the DRC sign is always present in scoliotic lateral spinal radiographs with no exception. This observation supports our hypothesis that in idiopathic scoliosis, the deformity of the thorax develops first and then the deformity of the spine follows.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: found
            Is Open Access

            Study of trunk asymmetry in normal children and adolescents

            The scoliometer readings in both standing and sitting position of 2071 children and adolescents (1099 boys and 972 girls) aged from 5 to 18 years old were studied. The angle of trunk rotation (ATR) was measured, in order to quantify the existing trunk asymmetry. Children and adolescents were divided in two groups according to the severity of trunk asymmetry. In the first group asymmetry was 1 to 6 degrees and in the second group was 7 or more degrees. Radiographic and leg length inequality evaluation were also performed in a number of children. The mean frequency of symmetric (ATR = 0 degrees) boys and girls was 67.06% and 65.01% for the standing screening position and 76.5% and 75.1% for the sitting position, respectively. The mean difference of frequency of asymmetry (ATR > 0 degrees) at standing minus sitting forward bending position for boys and girls was 10.22% and 9.37%, respectively. The mean frequency of asymmetry of 7 or more degrees was 3.23% for boys and 3.92% for girls at the standing forward bending position and 1.62% and 2.21% at the sitting, respectively. Girls are found to express higher frequency of asymmetry than boys. Right trunk asymmetry was more common than left. The sitting position is the preferred screening position for examining the rib or loin hump during school screening as it demonstrates the best correlation with the spinal deformity exposing the real trunk asymmetry.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Discordance in spinal and thoracic correction using powerful full screw constructs in idiopathic scoliotic.

              The pre and postoperative rib-vertebra angles and Cobb angles in patients with idiopathic scoliosis pre and post operatively treated with full transpedicular screw constructs were compared. Eighteen patients had right thoracic curves while only two had a left curve. 7 curves were Lenke's type 3C, 6 type 5C, 4 type 1A, 3 type 6C and one type 2A. Convex side showed larger RVAs compared to the concaved side. The rib vertebra angle decreased from T1 to T12. The rib vertebra angles pre operatively (left vs right) were significantly different in every single level apart from T1, T7, T8 and T9. Cobb angle significantly improved post - operatively (p=0.0001). The post-operative rib vertebra angle differences significantly differed at all levels (p>0.05), but not in the region spanning the thoracic apex (T6-T7-T8). The powerful full-screw instrumentation corrects the Cobb angle very satisfactorily, but only partially corrects the rib cage asymmetry as this is expressed by the rib vertebra angle differences pre and post operatively. The small or no effect on the stiff apical ribs (T6-T8) and the possible role of the related musculature need to be further evaluated and analyzed.
                Bookmark

                Author and article information

                Contributors
                Conference
                Scoliosis
                Scoliosis
                Scoliosis
                BioMed Central
                1748-7161
                2015
                11 February 2015
                : 10
                : Suppl 2
                : S10
                Affiliations
                [1 ]1st Department of Orthopaedics, University of Athens, Medical School, University General Hospital ATTIKON, Chaidari, Athens 12462, Greece
                [2 ]Department of Orthopaedics and Traumatology, “Tzaneio” General Hospital of Piraeus, Tzani and Afendouli 1, Piraeus 18536, Greece
                Article
                1748-7161-10-S2-S10
                10.1186/1748-7161-10-S2-S10
                4331727
                25810758
                2ba841f4-3de4-43c1-9724-f5828bd95f54
                Copyright © 2015 Soultanis et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                10th International Research Society of Spinal Deformities (IRSSD)
                Sapporo, Japan
                29 June-2 July 2014
                History
                Categories
                Research

                Orthopedics
                Orthopedics

                Comments

                Comment on this article