Impact of direct vertebral body derotation on rib prominence: are preoperative factors predictive of changes in rib prominence?

STUDY DESIGN: Multicenter retrospective review of prospectively collected data. OBJECTIVE: To determine the extent of rib deformity correction that can be expected with direct vertebral body derotation (DVBD) and investigate factors that may correlate with improved rib deformity correction. SUMMARY OF BACKGROUND DATA: DVBD is a powerful tool in the surgical correction of axial rotation in adolescent idiopathic scoliosis. The application of DVBD has decreased the use of thoracoplasty for cosmetic rib deformity correction, but the outcomes of DVBD without adjuvant thoracoplasty have not been well defined. METHODS: A multicenter database was retrospectively queried to identify patients with adolescent idiopathic scoliosis who underwent posterior spinal fusion with at least 2 years of follow-up and Lenke type 1 to 3 curves. All patients had undergone DVBD maneuvers during their surgery, and patients having undergone concurrent thoracoplasty were excluded from the study. The absolute change and percentage change from preoperative inclinometer readings were correlated with preoperative clinical and radiographic data. RESULTS: A total of 148 patients fulfilled the inclusion criteria. The mean age was 14.7 ± 2.1 years with a mean primary thoracic curve of 55.3° ± 9.3°. The mean preoperative inclinometer reading was 14.8° ± 4.5°, which reduced to 7.5° ± 4.0° postoperatively. Patients had a mean improvement of 54% ± 29% in rib prominence using DVBD. We attempted to correlate 23 of the most commonly used preoperative clinical, radiographic, and operative measures with postoperative inclinometer improvement. Interestingly, none correlated with rib deformity correction, including preoperative rib deformity (P = 0.16), thoracic curve flexibility (P = 0.71), presence of osteotomies (P = 0.60), and thoracic curve magnitude (P = 0.78). CONCLUSION: Utilizing DVBD, the surgeon can expect approximately 50% reduction in the rib deformity as assessed by inclinometer. This is irrespective of preoperative inclinometer measures, thoracic curve flexibility, and vertebral body rotation on standing and bending radiographs.

[Computerized modelling of operation (CMO) before thoracoplasty]. / Thoraco-myoplastica mutéteink számítógépes modellezése és tervezése.

INTRODUCTION: Thoraco-myoplasty (TMP) has proven to be the only successful method of treatment for severe cases of chronic pyothorax (CPT). Great loss of muscle tissue and permanent bone-structure defects with severe functional damage can be caused by this method. The aim of the applied CMO was to prevent additional loss of muscle function. Preoperative evaluation of spiral CT scan 3-dimensional imaging provided a significant aid in decreasing adverse effects of the TMP. MATERIALS AND METHOD: Between 1990 and 2010, TMP was applied in 85 patients, whose CPT came from several different origins. CLINICAL DATA: average age: 62.7; mortality: 4.8%. Tissue and function preserving TMP was achieved following open treatment after thoracic fenestration in 76 cases, and drainage with continuous suction was performed in 9 patients prior to this. In our department TMP with computerized modeling was introduced as the definitive treatment of CPT in 2006, since then it has been applied in 8 patients. RESULTS: The number and length of the ribs to be resected can be anticipated applying spiral CT imaging. Furthermore, accurate volume measurement of the empyema cavity and rotatable muscles (pectoral major and latissimus dorsal) faciliatates elimination of the primary defect during surgery. CONCLUSION: Therefore, we believe that CMO can provide significant aid for surgeons to reduce the negative effects caused by muscle trauma and the structural changes in the thoracic wall.

Resección de pared torácica en patología tumoral y no tumoral: empleo de prótesis con resinas acrílicas / Chest wall resection in tumoral and non tumoral pathology: use of heterologous prothesis

Antecedentes: Las resecciones de pared torácica representan la forma terapéutica más eficaz para un número apreciable de pacientes portadores de patología tumoral o no tumoral. Objetivo: Reconstruir desde el punto de vista funcional y estético. Diseño: Retrospectivo, descriptivo. Población: 57 pacientes con patología de la pared torácica, 23 con lesiones benignas (12 tumorales; 11 no tumorales) y 35 con tumores malignos: 16 primarios; 5 metastásicos; 13 recidivas loco-regionales y 1 carcinoma mediastinal con invasión parietal. Entre los tumores primarios predominaron los sarcomas mientras que entre los secundarios los carcinomas. Método: Fueron resecados 55 pacientes: 33 por tumores malignos; 11 por tumores benignos y 11 por lesiones no tumorales (5 úlceras actínicas; 4 osteomielitis; 1 pseudo-tumor inflamatorio; 1 fractura patológica por rarefacción actínica). En 27 oportunidades se emplearon prótesis heterológicas: 24 Marlex-Metilmetacrilato, 2 Marlex exclusivamente y 1 Polipropileno. Dichas prótesis se cubrieron con colgajos miocutáneos, musculares únicamente, epiplón mayor o bien con tejidos vecinos. Resultados: El índice de morbilidad fue 20,3 por ciento, aunque el 82 por ciento consistió en complicaciones banales. Sólo 3 pacientes requirieron algún procedimiento adicional. La supervivencia global actuarial a 5 años de los pacientes con patología maligna fue de 63 por ciento para los sarcomas y 31 por ciento para los carcinomas. De los pacientes operados por recidiva loco-regional de Ca de mama, el 22 por ciento estaban vivos a los 5 años y el 11 por ciento a los 10 años, falleciendo el resto por pregresión de la enfermedad. Analizando los pacientes portadores de metástasis y recidiva loco-regional, la supervivencia media fue de 37,5 meses con una supervivencia a los 5 años de 23 por ciento. Conclusiones: En la patología tumoral de la pared torácica deben evitarse las resecciones económicas dado que exponen a soluciones oncológicas insuficientes. La evaluación de estos enfermos debe ser multidisciplinaria y la actuación de cirujanos reparadores no puede estar ausente