Introduction
Materials and methods
Results
Age (yrs) | Sex | Curve (Apex, Cobb angle); displaced rib(s) | Signs & symptoms | Diagnosis made on | Cord impingement/compression | Presence of neurofibroma | Management |
---|---|---|---|---|---|---|---|
14 | M | Levoscoliosis (61°); convex side left 4th rib | Back pain; mild lower limb hyperreflexia and ankle clonus | CT, MRI | No | Yes | T4 laminectomy with rib head resection and posterior fusion/instrumentation |
11 | F | Hemivertebra T9; Dextroscoliosis T9 (123°); Kyphosis (62°); convex side right 10th rib | Asymptomatic | CT, MRI | Yes | No | Multilevel diskectomies, T9 laminectoy and posterior fusion with resection of 10th rib head |
11 | M | Dextroscoliosis (90°); Kyphosis (85°); convex side right 9th rib | Asymptomatic | CT, MRI | No | No | 9th rib head resection, anterior and posterior fusion and T9 laminectomy |
9 | F | Dextroscoliosis (60°); convex side right 6th rib | Back pain; right foot weakness, hyper-reflexia and clonus | CT, MRI | Yes | Yes | Resection of neurofibroma and 6th rib head; combined anterior and posterior fusion and instrumentation |
Authors | Age (yrs) | Sex | Curve (Apex, Cobb angle); displaced rib(s) | Signs & Symptoms | Diagnosis Made on | Cord impingement/compression | Presence of Neuro-fibroma | Management |
---|---|---|---|---|---|---|---|---|
Flood et al. | 15 | M | Dextroscoliosis T4–T8 (80°); multiple ribs on convex side | Knee & ankle clonus | CT-M | No | Yes | Two-stage vertebral wedge resection with rib excision and fusion. Traction used perioperatively. Curve decrease to 45 degrees with resolution of clonus |
Major et al. | ||||||||
13 | F | Levokyphoscoliosis (T9, 52°); convex 8, 9 & 10th ribs | Transient loss of sensation below the waist and inability to move lower extremities after fall on rib hump | CT-M | No | No | Two-stage: anterior fusion with resection of rib heads followed by 2nd stage posterior fusion and segmental spinal instrumentation | |
5 | F | Levoscoliosis (T7, 75); two ribs on convex side | None | CT | No | No | Two-stage: anterior interbody fusion with resection of rib heads followed by 2nd stage posterior fusion and segmental spinal instrumentation | |
11 | M | Double thoracic scoliosis (29°); convex side 4th rib | None | CT-M | No | No | Posterior fusion with resection of rib head | |
Deguchi et al. | 12 | F | Dextrokyphoscoliosis T4–T7 (T5, 90°); convex side 5 & 6th ribs | Weakness of the lower extremities, difficulty walking with eventual paraparesis, hyperesthesia below waist, ankle clonus and knee/ankle hyperreflexia | CT-M | Yes | No | Two-stage combined anterior and posterior spinal fusion and instrumentation. Dislocated rib head was resected. 2 yr f/u with normal neurological status |
Dacher et al. | 10 | F | Dextroscoliosis (T8, 48°); convex side 8th rib | Bilateral ankle clonus and daytime micturition | CT-M | No | No | Two-stage spinal fusion with Cotrel-Dubousset instrumentation. 1 yr f/u with normal neurological status |
Kamath et al. | 13 | M | Dextroscoliosis T7–T11; convex side 10 h rib | None | CT | No | Yes | Intraspinal rib head resection with right T9–10 hemilaminectomy and posterior fusion/instrumentation |
Khoshhal et al. | 16 | M | Dextroscoliosis T3–T6 (T5, 83o); convex side 5th rib | Postoperative T5 paraparesis | CT | Yes | No | Initially performed in situ posterior fusion without correction or instrumentation. Anterior decompression with rib head resection was performed after T5 paraparesis developed |
Mukhtar et al. | 10 | M | Dextroscoliosis T4–T12 (76o); convex side 9th rib | Back pain; right leg weakness and radiculopathy down to toes when he rolled to his right side | CT and CT-M | Yes | No | Partial rib resection with rib head left in situ. Posterior fusion from T6 to L1 was performed |
Gkiokas et al. | 13 | F | Levokyphoscoliosis T4–T10 (T8, 75o); convex side 8th rib | Gait difficulty, bilateral Bobinski, ankle clonus, right foot drop, decreased sensation/hyperreflexia in lower limbs, and daytime micturition | CT, MRI | Yes | No | Rib head resection with posterior spinal fusion/instrumentation from T1 to L2. Cobb angle postoperatively was 65 and patient neurological status returned to baseline |
Crawford et al. | ||||||||
5 |
a
| Cervicothoracic kyphoscoliosis Protrusion of three rib heads |
a
| CT |
a
|
a
|
a
| |
a
|
a
| Protrusion of one rib head |
a
| CT |
a
|
a
|
a
| |
a
|
a
| Protrusion of one rib head | Asymptomatic | CT |
a
| Yes |
a
| |
Yalcin et al. | ||||||||
14 | M | Dextroscoliosis; convex side two ribs | None | CT, MRI | Yes | Yes | Hemilaminectomy followed by rib head resection and posterior fusion with instrumentation | |
12 | F | Dextroscoliosis T8–L1; convex side rib | None | CT | No | Yes | Hemilaminectomy followed by vertebral translation and pedicle screw fixation. Rib head was not resected | |
6 | M | Levoscoliosis TL spine; convex side 10 & 11th ribs | None | Radio-graphs & CT | Yes | Yes | 5-level annulotomy with resection but not removal of displaced rib heads. Deformity correction with fusionless instrumentation with pedicle screws | |
Cappella et al. | ||||||||
14 | M | Double thoracic kyphoscoliosis (kyphosis 120o); convex side 5th rib | Preoperative weakness of lower limbs. Postoperative weakness and paraparesis | CT, MRI | Yes | No | Initially performed two-stage anterior and posterior instrumentation and arthrodesis. Subsequently, rib head resected and posterior cord decompression after postoperative paraparesis developed |