An-Najah Staff

Aim   Current methods ( Growing rod and VEPTR ) for the management of early onset scoliosis associated with kyphosis have not been satisfactory . We introduce a new method of proximal rib fixation that has performed very well .

Methods  Records and radiographs of 18 patients ( 14 in Palestine , 4 in Charlestone S.C USA) with early onset scoliosis who were treated with the non fusion 4 rib construct surgical technique from August 2007-April 2009 , with mean followup time of 28 months ( 24-44 months )

Surgical technique includes bilateral 4.5 rods with proximal fixation with 4 hooks of the 4 adjacent ribs beginning from 2^nd rib with the 2 proximal hooks facing downwards and the distal ones facing upwards .Distal fixation with spinal or iliac screws .

Results

Complications Eleven complications were detected with only one case of proximal dislodgment and non experienced neurological complications

Conclusion we believe thatthe 4 rib constructhas advantages in the management of early onset scoliosis especially when associated with kyphosis because of its

1-    Easy application

2-    Strong anchor proximally

3-    Avoidance of kyphogenic effect secondary to rod lengthening

4-    Adjusment of the rod to control the apex with the cantilever effect

5-    Long lever arm without fusion

6-    No need for post operative brace with the dua rod

Significance

Treatment of early onset deformity associated with kyphosis has been difficult with current methods .

The 4 rib construct method has been more reliable than currently used methods for proximal fixation in this patient population