Costodesis and contralateral rib release in the management of progressive scoliosis

This paper reports on 41 immature patients whose scoliosis was treated by fixation of ribs on the convexity. All had progressive scoliosis, the curve deteriorating at more than 10 degrees p.a., or the rib-vertebra angle difference being greater than 20 degrees. Of the 24 with infantile idiopathic scoliosis examined 5 years after operation, 10 maintained the improvement obtained at operation and in a further 19 the rate of deterioration had been slowed. Factors leading to a favourable outcome included: 1) An initial rib-vertebra angle difference of less than 30 degrees. 2) Success in achieving convex rib fusion. 3) The use of the operation in patients with infantile idiopathic scoliosis. There was a less favourable outcome in congenital and adolescent scoliosis. Spirometric volumes were diminished immediately after operation. Costodesis is therefore contraindicated in patients with precarious respiratory function.