Children with congenital thoracic scoliosis associated with fused ribs with
a unilateral unsegmented bar adjacent to convex hemivertebrae will invariably
have curve progression without treatment. Surgery has been thought to have a
negligible growth-inhibition effect on the thoracic spine in such patients
because it has been assumed that the concave side of the curve and the
unilateral unsegmented bar do not grow, but we are unaware of any conclusive
studies regarding this assumption.
The changes in the length of the concave and convex sides, anterior and
posterior vertebral edges, posterior arch, and unilateral unsegmented bars of
the thoracic spine were measured in the twenty-one children with congenital
scoliosis and fused ribs after expansion thoracoplasty had been carried out
with use of a vertical, expandable titanium prosthetic rib. Three of these
children hadundergone posterior spinal fusion previously. Measurements were
made with use of a three-dimensional software program that analyzed baseline
and follow-up computed tomography scans. The technique was validated through
measurement of the thorax of a small female adult cadaver.
The patients without spine fusion had an average age of 3.3 years at the
time of the baseline computed tomography scan, and the average duration of
follow-up was 4.2 years. On the average, these patients showed significant
growth (p < 0.0001) of the concave side of the thoracic spine (an increase
in length of 7.9 mm/yr, or 7.1%/yr) and the convex side (8.3 mm/yr, or
6.4%/yr) compared with the baseline lengths. There was no significant
difference in the increases in length (p = 0.38) between the concave and
convex sides. Eleven patients with an unsegmented bar had an average 7.3%
increase in the length of the bar (p < 0.0001). In the three children with
prior spinal fusion, the increase in length averaged only 4.6 mm/yr (3%/yr) on
the concave side of the thoracic spine and 3.7 mm/yr (2.2%/yr) on the convex
side; both increases were significant (p < 0.0001).
Longitudinal growth of the thoracic spine in a normal child has been
estimated to be 0.6 cm/yr between the ages of five and nine years. After
expansion thoracoplasty, growth of the thoracic spine was approximately 8
mm/yr in our series of children with congenital scoliosis and fused ribs.
After expansion thoracoplasty, both the concave and the convex side of the
thoracic spine and unilateral unsegmented bars appeared to grow in these
patients. When a thorax is already foreshortened by congenital scoliosis,
control of spine deformity with expansion thoracoplasty allows growth of the
thoracic spine, and it is likely that the longer thorax provides additional
volume for growth of the underlying lungs with probable clinical benefit.