Aim   Current methods ( Growing rod and VEPTR ) for the management of early onset scoliosis associated with kyphosis have not been satisfactory . We introduce a new method of proximal rib fixation that has performed very well .

Methods  Records and radiographs of 18 patients ( 14 in Palestine , 4 in Charlestone S.C USA) with early onset scoliosis who were treated with the non fusion 4 rib construct surgical technique from August 2007-April 2009 , with mean followup time of 28 months ( 24-44 months )

Surgical technique includes bilateral 4.5 rods with proximal fixation with 4 hooks of the 4 adjacent ribs beginning from 2^nd rib with the 2 proximal hooks facing downwards and the distal ones facing upwards .Distal fixation with spinal or iliac screws .

Type of deformity

Scoliosis

Kyphoscoliosis

Kyphosis

Number of patients

9

6

3

Results

Type of deformity

Scoliosis

Thoracic kyphosis

Thoracolumbar kyphosis

Mean peroperative angle

82

93

62

Mean postop.angle

52

62

26

Complications Eleven complications were detected with only one case of proximal dislodgment and non experienced neurological complications

Conclusion we believe thatthe 4 rib constructhas advantages in the management of early onset scoliosis especially when associated with kyphosis because of its

1-    Easy application

2-    Strong anchor proximally

3-    Avoidance of kyphogenic effect secondary to rod lengthening

4-    Adjusment of the rod to control the apex with the cantilever effect

5-    Long lever arm without fusion

6-    No need for post operative brace with the dua rod

 

Significance

Treatment of early onset deformity associated with kyphosis has been difficult with current methods .

The 4 rib construct method has been more reliable than currently used methods for proximal fixation in this patient population 

Title

Journal of Children's Orthopaedics

Publisher

--

Publisher Country

Palestine

Publication Type

Both (Printed and Online)

Volume

--

Year

2012

Pages

--