Combining video-assisted thoracoscopic release and costoplasty in treating severe idiopathic scoliosis: A case report

A staged operation, with anterior releases, multiple discectomies and fusion, followed by a posterior fusion and instrumentation, is recommended in treating a rigid and severe idiopathic scoliosis. Technically, correction of the lateral spinal curvature may have no effect on the rib hump prominence. Thoracoplasty, also called costoplasty, in scoliosis surgery, is recognized as a technique that might permit a reduction of rib deformity and serves as an ample source for bone grafting. Such a procedure can be accomplished via a posterior midline approach (external thoracoplasty), or from, within the chest (internal thoracoplasty). Video-assisted thoracoscopic surgery (VATS) is a recently developed technique in the management of spinal disorder. Herein, we report a 13-year-old girl with a severe idiopathic scoliosis, T2 to T11 measuring 96°, and T11 to L4, 84°The rib hump deformity was measured at 27°using a Bunnell's scoliometer at the most prominent area. She initially underwent VATS anter-ior releases and costoplasty, followed by posterior fusion, instrumentation and external thoracoplasty. Regeneration of the ribs was seen on the 6-month postoperative radiograph. Only ribs were harvested as autogenous bone grafting without adding any iliac bone graft. At the 18-month follow-up, the rib hump deformity was measured at 5°using a Bunnell's scolio-meter. She was freely ambulatory with a good maintenance of the scoliosis correction, and solid fusion was achieved at both the thoracic and the lumbar segments.