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Three-dimensional computed tomographic volume rendering techniques in endoscopic thoracoplasty.

I H Lieberman1, R R Kuzhupilly, M K Reinhardt

  • 1Department of Orthopedic Surgery and Radiology, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA. lieberi@ccf.org

The Spine Journal : Official Journal of the North American Spine Society
|November 1, 2003
PubMed
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Three-dimensional CT volume rendering reliably plans endoscopic rib resection for scoliosis rib humps. This minimally invasive technique achieves excellent cosmetic results with less morbidity.

Area of Science:

  • Orthopedics
  • Radiology
  • Minimally Invasive Surgery

Background:

  • Thoracoplasty is used for rib hump correction in scoliosis, but open resections have significant morbidity and scarring.
  • Endoscopic techniques offer a less invasive alternative for rib hump correction.

Purpose of the Study:

  • To evaluate the utility of 3D CT volume rendering in preoperative planning for endoscopic rib resection.
  • To assess the accuracy of 3D CT volume rendering in estimating rib resection length and portal placement.

Main Methods:

  • Prospective evaluation of four patients with fused scoliosis and rib humps undergoing endoscopic thoracoplasty.
  • Preoperative 3D CT volume rendering used to create a vector plane for planning rib resection and portal sites.
  • Comparison of estimated vs. actual rib resection length and portal accuracy during surgery.

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  • Postoperative assessment included clinical examination, patient satisfaction, and repeat CT scans.

    • Main Results:

    • 3D CT planning accurately guided portal placement and rib resection lengths.
    • Endoscopic resection achieved the desired correction, with the elevated scapula descending into the resection bed.
    • All patients achieved excellent cosmetic results, confirmed by clinical assessment and CT scans.
    • Average blood loss was 307 ml, and average hospital stay was 4.75 days.

    Conclusions:

    • 3D CT volume rendering is a reliable tool for planning minimally invasive endoscopic thoracoplasty for rib hump correction.
    • This technique allows for precise estimation of rib resection, leading to successful cosmetic outcomes.