1. The rib construct for management of early onset kyphotic deformity

2. Initial patient note sternum “pulled out” of stomach
Result 7 yrs later prominent rib hooks replaced with screws convex side at definitive fusion
12 yo with VATER syndrome
Rib construct

3. Biomechanical testing
Porcine spines, /-1.3 kg, 6 in each group. Loaded from 0-90°. All 6 pedicle screw constructs failed /- 1.3 °. No rib construct failed.

4. Clinical Results 14 patients early onset kyphosis
4 syndromic
4 congenital
3 idiopathic
2 neuromuscular
1 juvenile osteoporosis
Followup mos (49)
Age initial surgery months (84)
Congental
kyphosis
3 patients with T1-5 kyphosis > 20°, preop T1-5 24°,total kyphosis 42; postop T1-5, 17.3°, total kyphosis 37°
11 patients with T1-12 kyphosis >70°,
average preop 104°, postop 66°
Neurofibromatosis- preop 134°, postop 55°
NO PJK!!