Peter Metz-Stavenhagen and Walter Morgenstern

Goals of Surgical Treatment

Release the curvature; reconstruct the thoracic deformity and sagittal profile for efficient correction of the deformity; horizontalize the end vertebrae by distribution of distraction forces.

Diagnosis

Idiopathic thoracic scoliosis is defined as a lordotic deformity. The apex of the curve is between T2 and T11-T12. Due to rotation, a rib-hump occurs on the convexity of the curve with structural deformation of the rib. On the concavity the ribs are bent anteriorly, producing the lordotic component of the deformity. Other thoracic deformations are shoulder imbalance, waist asymmetry. To establish the diagnosis, anteroposterior (AP) and lateral x-rays of the spine are taken on a long cassette, as well as bending films, extension films, and rib-hump exposures.

Indications for Surgery

1. Pronounced thoracic scoliosis in adolescents and adults: stiff thoracic curves (bending less than 50 % correction)

2. Significant cosmetic deformation

3. Congenital thoracic curves [preoperative magnetic resonance imaging (MRI) and myelogram mandatory]

Contraindications

1. Patients with severe pulmonary diseases

2. Patients with less severe thoracic deformity (rib-hump)

Advantages of Posterior Correction with Concave Thoracoplasty

1. Increased correction of frontal plane deformity

2. Improved horizontalization of the end vertebra with superior cosmetic results