Pulmonary function after thoracoplasty for adolescent idiopathic scoliosis
Abstract
A meta-analysis quantifying the respiratory cost of cosmetic rib resection (thoracoplasty) in scoliosis surgery. Data confirms the procedure is safe, causing only a transient, clinically negligible decline in lung volumes.
Cosmetic Gain vs. Pulmonary Cost
Key Finding
"Thoracoplasty resulted in a statistically significant but clinically irrelevant decline in predicted FVC (-4.6%) and FEV1 (-5.2%) compared to spinal fusion alone."
Background: The rib hump is a major source of cosmetic distress in Adolescent Idiopathic Scoliosis (AIS). Thoracoplasty offers dramatic cosmetic correction but is often avoided due to fears of compromising chest wall mechanics and lung function. This study sought to definitively answer whether the cosmetic benefit justifies the respiratory risk.
Methods: A meta-analysis of 10 studies including 385 patients. The authors compared preoperative and postoperative Pulmonary Function Tests (PFTs), specifically Forced Vital Capacity (FVC) and Forced Expiratory Volume in 1 second (FEV1). The analysis controlled for spinal fusion approaches (Anterior vs. Posterior) to isolate the specific impact of the rib resection.
Results: While statistical analysis showed a decrease in pulmonary parameters (FVC and FEV1 dropped by ~5%), these values remained well within the normal functional range for adolescents. Long-term follow-up (> 2 years) indicated that this decline is often transient, with lung function recovering as chest wall compliance adapts. There was no evidence of permanent respiratory crippling or increased rate of pulmonary complications.
Conclusion: The fear of thoracoplasty is overstated. The procedure provides superior cosmetic satisfaction with a price of < 6% lung volume—a trade-off that is clinically undetectable in the active adolescent. Surgeons should not withhold this cosmetic adjunct based on pulmonary concerns.