Introduction: There are few long-term studies after Zielke ventral derotation spondylodesis (VDS). We present a minimum 17 year follow-up study to assess factors predicting distal adjacent disc degeneration.

Material/Methods: Twenty-eight patients with thora-columbar AIS operated in 1982 have been retrospectively evaluated. Mean age 16,3 years, minimum follow-up 15 years. Anterior fusion was performed with rib graft.

Results: Mean pre-op Cobb angle was 65 ± 23°, post-op correction rate was 61,2 ± 12,4%. Mean angulation of end vertebra was 32 ± 10°, post-op corrected to a mean of 8° (correction rate 79%). Mean post-op Th10/L2 kyphosis was 10°. Rod breakage was seen in 17 patients.

Conclusion: Thoracolumbar kyphosis was associated both with proximal implant breakage and with segmental lordosis and degeneration of the distal adjacent segment. Disc angulation in the AP plane seems to be good tolerated. Anterior support with iliac bone graft or cages is expected to overcome these complications.

Introduction: In rigid AIS, the main resistance for thoracic derotation are the anteriorly rotated ribs on the concavity. This study presents clinical and radiographic long term results of the CTP, which is a routine surgical procedure at the authors’ institution.

Material and Methods: Between 1996 and 1997 we have operated on 466 cases of scoliosis. 36 patients with thoracic AIS were evaluated. Technique: The ribs on the concave side are osteotomised close to the costo-transverse joint and elevated over the bended rod.

Results: Mean follow up was 6.4 y. Mean preoperative side bending flexibility was 21%. Mean correction rate was 68%, mean rib hump correction was 3cm. Mean loss of correction 4°. There was no neurological complication, and pulmonary morbidity was not increased.

Conclusion: In rigid thoracic scoliosis, a release of the concave ribs by means of the CTP can both significantly increase the extent of correction and contributes to an excellent cosmetic result.