Improved pulmonary function after concave rib resection and posterior instrumentation for idiopathic scoliosis

The authors conducted a prospective study in order to evaluate the effect'of concave rib osteotomy on pulmonary function, in the context of posterior instrumentation for the treatment of idiopathic scoliosis. Concave rib osteotomy improves the flexibility of the spine, especially in very rigid curves above 70. Seventy-eight consecutive children with a Cobb angle above 70 degrees were included in the study. Pulmonary function was measured preoperatively and at 12 months postoperatively. After surgery, all patients took part at an intense pulmonary rehabilitation program. The mean preoperative Cobb angle of 91.70 improved to an average of 29.50. Unexpectedly, the postoperative pulmonary function, measured as an absolute value after one year, was significantly better than the preoperative pulmonary function. Very probably the concave rib osteotomy had allowed expansion of the thoracic cage. Most other studies about scoliosis surgery with disruption of the rib cage have reported a stabilized or a diminished pulmonary function. An exception might be the use of expansion thoracostomy with insertion of vertical expandable prosthetic titanium ribs in congenital scoliosis.