Minimally Invasive, Endoscopic, Internal Thoracoplasty for the Treatment of Scoliotic Rib Hump Deformity: Technical Note

Abstract

Patients with idiopathic scoliosis often have a noticeable rib deformity that frequently persists after corrective surgery. Open thoracoplasty has been the traditional method of reducing rib deformity. Recently, however, video-assisted thoracoscopy (VATS) has been used to perform thoracoplasty. There have been no long-term follow-up studies on VATS thoracoplasty, nor have there been outcome scores to assess the results of thoracoplasty procedures. We present our experience using VATS thoracoplasty with long-term follow-up and propose an outcome grading system for thoracoplasty. Between 1998 and 2000, four patients (age range, 14-53 yr) underwent VATS thoracoplasty for significant rib hump deformity (mean height, 5 cm; range, 4-6 cm) associated with idiopathic scoliosis. All patients had four rib segments resected during the VATS thoracoplasty procedure. Three of the four patients also underwent anterior thoracic release and discectomy during the procedure. Patients were followed for a mean of 40 months after surgery (range, 33-50 mo). There were no intraoperative or postoperative complications. Outcomes were assessed using a patient questionnaire with our new thoracoplasty grading system. All patients were pleased that they had chosen to have VATS internal thoracoplasty. Based on our new grading system, two patients had an excellent outcome and two had a good outcome. VATS provides an alternative, minimally invasive route to perform thoracoplasty. VATS incisions are much smaller and more cosmetically appealing than open thoracoplasty incisions. Long-term follow-up indicates good to excellent patient outcomes.