Purpose: To determine the incidence and outcome of late costoplasty in surgical management of IdS.

Methods and results: A retrospective review of prospectively collected data on patients with IdS who underwent costoplasty after definitive fusion during a 10 year period (1994–2004).

We reviewed surgical records of 318 patients who underwent instrumented spinal fusion for IdS at our centre. Amongst these, 15 patients had undergone late costoplasty. Pre-operative assessment included rib hump measurement, photographs and plain radiographs. 4 patients had computerised tomography to evaluate deformity. Outcome measures included patient satisfaction and clinical evaluation.

Results [Mean (SD)]: Age at primary operation was 12.3(3.3) years; age at costoplasty 17.1(2.7) years. Pre-operative Cobb angle was 64.1 (19.5) and postoperative Cobb 36.9 (15.7) degrees. Median time between primary operation and costoplasty was 4 years. Median follow up was 7 years. Indication for costoplasty was cosmetic deformity with prominent rib hump (n=9) and curve progression (n=6). Approach at primary operation was anterior 1 case, posterior 3 and combined 9 cases. Median length of stay was 5 days.

All patients except 1 had significant reduction in rib hump deformity. Complications included 1 case of surgical scar tenderness, 1 transient neuralgia and 1 patient required a chest drain due to haemothorax.

Discussion: Costoplasty is a cosmetic procedure for the correction of rib prominence in scoliosis. There is low incidence of late costoplasty (i.e. after definitive spinal fusion) in IdS. Following costoplasty, patients were satisfied with their cosmetic appearance; no major complications occurred and no further reoperation was needed.

Ethics approval: Audit/service standard in trust number: 1236

Interest Statement: None

Purpose: To determine frequency of reoperations after definitive spinal fusion in patients with AIS and identify factors responsible

Methods and results: We undertook a retrospective review of surgical logs of patients with AIS who underwent surgical fixation during 1994–2004 and detailed case notes review of patients who required > 1 operation after definitive fusion. Results were compared according to approach used during primary operation.

We reviewed surgical logs of 310 patients who underwent instrumented spinal fusion for AIS. Approach at primary operation was anterior 101, posterior 109 and combined 100. Of these, 33 patients underwent 58 reoperations (10.6 %) after definitive fusion. Median age was 14.7 years; median follow up 5.4 years. Amongst these, primary operation was Anterior in 5 patients (7 reoperations, 5%), Posterior 13 patients (25 re-ops, 11.9%) and Combined 15 patients (26 re-ops, 15%). 12 patients required more than 1 reoperation.

Common indications were infection (9), failure of fixation either due to curve progression (10), junctional kyphosis (7) or pseudoarthrosis (3). 16 revisions were undertaken due to implant related symptoms. 5 patients with posterior instrumentation requested removal of implant. Only 1 patient had a neurological deficit that required removal of implant. 13 patients required secondary costoplasty.

Discussion: Risk of reoperation after definitive fusion in AIS is 10.6 % in our institution. Reoperation rates were maximal with combined approach and least with anterior approach (15% v 5%). Common indication with posterior instrumentation was implant related and in anterior surgery due to curve progression (wrong level fixation).

Ethics approval: Audit/service standard in trust number: 1236

Interest Statement: None