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PubMedDate not supplied

Usefulness of biodegradable absorbable rib connecting pins in thoracoabdominal hepatectomy.

BACKGROUND/AIMS: Some patients who undergo thoracoabdominal hepatectomy suffer from pain and discomfort after because rib and/or costal cartilage was cut during the operation. The usefulness of absorbable rib connecting pins in thoracoabdominal hepatectomy was evaluated. METHODOLOGY: Of 18 patients who underwent thoracoabdominal hepatectomy, the stumps of ribs were not fixed in 9 patients (group 1) and the stumps of ribs were fixed with the rib connecting pins in 9 other patients (group 2). We evaluated the usefulness of these pins in thoracoabdominal hepatectomy. RESULTS: In 8 patients in group 1 and 2 patients in group 2, pain continued for 1 month after the operation (p = 0.015). At 2 months after the operation, pain continued in 6 patients in group 1 and no patients in group 2 (p = 0.009). At 6 months after the operation, 2 patients in group 1 still had pain. Rib instability continued in 8 patients in group 1 at 6 months after the operation, although rib instability disappeared by 2 months after the operation in all group 2 patients (p = 0.0004). CONCLUSIONS: Biodegradable absorbable pins for rib fixation are useful for preventing pain and discomfort around the cut stumps of ribs in thoracoabdominal hepatectomy.

Absorbable Implants↗
PubMed2002

Simulations of rib cage surgery for the management of scoliotic deformities.

Costoplasties are surgical options to treat rib cage deformities. The main concern of rib resections is often for the cosmetic improvement of the back shape of the patient. Other experimental and clinical studies have shown that a costoplasty can also produce mechanical correction of the spine. Based on the assumption that surgery on the rib cage can alter the equilibrium of forces acting on the spine, this study aims to investigate the biomechanical role of the ribs during the surgical treatment of scoliosis using a finite element model of the spine and rib cage. The model was generated from patient-specific geometric data. Concave side rib shortening and convex side rib lengthening have been simulated and evaluated. Slight post-operative immediate geometrical correction of the spine was found in any of the simulations. However, both kinds of simulation induced similar loads on the vertebral endplates. Resulting torques in the frontal plane tended to correct the scoliotic spine in the frontal plane acting against vertebral wedging. Important torques were also found in the sagittal plane, increasing the physiological kyphosis, and derotational torques promoted the improvement of the transverse plane deformation. This biomechanical analysis showed that appropriate rib surgery may counteract the progression of the spine deformity depending on the remaining growth potential. These findings support the concept of early interventions on the rib cage that may be a new approach of treatment to prevent curve progression in small to moderate idiopathic scoliotic deformities.

Computer Simulation↗
PubMed1978

Motion of the rib cage and the abdomen in tetraplegic patients.

1. We have studied the motion of the abdomen and the rib cage in patients with a transection of the lower cervical spinal cord during normal breathing both in the supine and sitting posture, and compared it with that of normal subjects. 2. In the supine posture the rib cage of a patient moves paradoxically inward, therefore his chest wall is deformed, which explains the high work of breathing. 3. During expiration, beside the recoil of the respiratory system, there is also the recoil of the deformed chest wall, toward its passive configuration, with an expansion of the rib cage above its resting position during the first part of expiration and an alteration of the expiratory flow profile. 4. In a sitting 'relaxed' posture the paradoxical inward motion disappears in the lower rib cage, and it is reduced but still present in the higher rib cage. 5. We conclude that contraction of the diaphragm constricts the 'passive rib cage', either directly through its insertions or indirectly through the reduction of intrathoracic pressure. In seated subjects the diaphragm causes some expansion of the rib cage at its lower level. Therefore the motion of the rib cage is not only related to the balance between the forces developed by the diaphragm and the intercostal muscles, but also to the diaphragm dome configuration, the geometry of the rib cage and the lung volume.

Abdomen↗
PubMed2004

Morphometric comparison of the pedicle rib unit to pedicles in the thoracic spine.

STUDY DESIGN: A radiographic study of the pedicle rib unit morphology as compared with measurements of the pedicle in cadaveric thoracic spines. OBJECTIVE: To evaluate the morphology of pedicle rib units in the thoracic spine in normal thoracic human spines, with particular attention to T4-T9, and to compare the dimensions of the pedicle rib unit with corresponding dimensions of the adjacent pedicles. SUMMARY OF BACKGROUND DATA: Despite the clinical successes reported with thoracic pedicle screw-rod constructs, controversy exists as to the safety of this technique in pedicles that are anatomically too small for transpedicular fixation. An alternative method of extrapedicular screw fixation within the pedicle rib unit was evaluated in a previous study and found to be anatomically feasible. Although the morphology of the pedicle rib unit was described in two previous studies, the measurements were obtained in scoliotic spines. Therefore, no study has sought to define the transverse dimension and chord length of the pedicle rib unit, and compare it with the corresponding pedicle dimensions. MATERIAL AND METHODS: Six fresh unfixed adult cadavers were obtained randomly. No history of spine disease was noted, and cause of death was unrelated to spinal disorder or trauma. The mean age was 84, with a range of 76 to 90. There were two females and four males. Computerized tomographic (CT) images of the thoracic spine were obtained. For cadavers in which the gantry resulted in oblique axial sections, reformatting was performed for more accurate measurements. Measurements of the transverse diameter and chord length of the pedicle rib unit were obtained and compared with measurements of the transverse pedicle width and chord length. RESULTS: The transverse width and chord length of the pedicle rib unit were significantly larger than corresponding pedicle measurements at all levels, a consistent finding when comparing the mean of all levels, the mean of T4-T9, and the mean of each individual level T4-T7. CONCLUSION: This study confirms the marked difference in size of the pedicle rib unit as compared with the pediclein both transverse width and chord length. This allows for a space that accommodates much larger major screw diameters, longer screw lengths, and because of the nature of screw placement, a greater screw convergence. Thus, there is anatomic potential for extrapedicular vertebral body fixation in the thoracic spine. However, care must be taken in placement of screws following precisely our previously described method of extrapedicular screw insertion. Penetration of surrounding structures, most notably the aorta on the left, is a potential risk when deviating from the method. Biomechanical evaluations are presently being conducted to evaluate the use of extrapedicular thoracic screw fixation.

Aged↗
PubMedDate not supplied

CT observation of rib abnormalities: spectrum of findings.

The CT studies in 63 patients in which rib abnormality was identified or excluded were retrospectively analyzed. The CT features were detailed and correlated with other available radiographic findings as well as clinical data. Contiguous spread of tumor to rib or metastasis to rib characteristically showed subtle or complete segmental lytic rib destruction. An accompanying extrapleural soft tissue mass was frequently seen with metastatic disease and myeloma. In nine patients CT showed rib destruction that had been obscured on chest radiography by heart, diaphragm, mass, or pleural effusion. Other imaging studies prompted consideration of neoplasm in seven patients in whom CT clearly showed benign post-traumatic or developmental lesions. Six patients had a clinically suspected chest wall mass excluded, leading to the diagnosis of Tietze syndrome. The ribs should be carefully inspected on all CT studies of the thorax and upper abdomen. Computed tomography is helpful when other imaging techniques, such as rib films or isotopic bone scans, have not resolved the question of clinically or radiographically suspected rib abnormality.

Adolescent↗
PubMed1985

Rib fracture healing in experimental flail chest.

Sixteen dogs were placed under general anesthesia and flail segments of the left chest were created by transecting ribs 7,8,9, and 10 anteriorly and posteriorly. Fractures were 10 cm apart so that a 10-cm flail segment encompassing four ribs was created. In Group I, the control (N = 5), the chest wall muscles were closed without any stabilization of the fractures. Group II (N = 5) had stabilization of both anterior and posterior fracture sites by polypropylene sutures. Group III (N = 6) had stabilization of the fractures in ribs 7 and 8 with 2.5-cm bone grafts taken from the left fourth rib. Ribs 9 and 10 were stabilized by polypropylene sutures. The study established a canine model for flail chest. It also showed that strut stabilization of rib fractures with bone grafts promotes better healing than suture stabilization. It suggests that using bone grafts taken from another rib to stabilize flail segments may be unsatisfactory since the rib used as a donor showed no signs of regeneration at 30 days.

Animals↗
PubMed2003

Rib defects in patterns of multiple malformations: a retrospective review and phenotypic analysis of 47 cases.

Rib anomalies may occur in isolation, as well as in association with abnormalities of vertebral segmentation and multi-system malformations. Specific entities include the VACTERL and MURCS associations, spondylocostal dysostosis, and spondylothoracic dysostosis. The relative significance of rib anomalies in other lesser known syndromes and associations remains unclear. To document the diagnoses and related defects in patients with rib anomalies as part of broader pattern of anomalies, we retrospectively identified 47 cases from a hospital population, and evaluated specific costal findings and associated birth defects. In our study, fusion was the most common pattern of rib anomaly (72%), followed by bifid (28%) and hypoplastic ribs (26%). Unrecognized patterns of multiple congenital anomalies (MCA) and VACTERL association were the commonest specific diagnoses with a frequency of 30 and 28%, respectively. An associated vertebral defect was found in 72% of the patients. Of those with no vertebral anomaly, the combinations of "rib and cardiac defects alone" and "rib and renal defects alone" were seen in one-third of the patients (4/13). Both the occurrence and type of rib anomaly were helpful in defining certain syndromes and enhanced the likelihood of identifying related malformations.

Abnormalities, Multiple↗
PubMed1992

Lateral dual-energy radiography: artifact error from rib and pelvic bone.

A lateral projection of the lumbar spine with dual-energy radiography (DER) may be a more sensitive tool for the detection of vertebral demineralization than the standard anterior-posterior (AP) DER measurement. The lateral view allows measurement of the vertebral body and selective measurement of the central trabecular compartment, excluding the majority of the cortical envelope and posterior vertebral elements. The lateral DER typically contains L2-4 in the region of interest. The present study was designed to investigate the frequency and bone mineral content (BMC) contribution of rib to the L2 vertebral body BMC measurement in a lateral view DER scan. In addition, the frequency of pelvic overlap of L4 was evaluated. All patients were scanned in the supine position. Abdominal CT images of L2 were examined in 20 women aged 28-82 years to determine the frequency of rib and pelvic interference. QCT images of L2 also were examined in an additional 35 women aged 20-82 years to further investigate the frequency of rib overlap and to calculate the potential contribution of rib superimposition to the L2 BMC in a lateral projection. Pelvic overlap of L4 occurred in 15% of the 20 cases reviewed. Rib overlapped the L2 vertebral body in 100% of the L2 images. The expected contribution of rib BMC to L2 BMC in a lateral DER scan was 10.4% on average. There was no relationship between the percentage of rib BMC contribution and age and relatively poor correlations between rib BMC and that of either the vertebral body or the central trabecular compartment of L2. We conclude that supine positioning allows routine inclusion of L3 and L4 in a lateral lumbar scan. Results also suggest that L2 should be excluded from DER scans on patients scanned in either the lateral decubitus or supine position.

Adult↗
PubMed1986

The induction of supernumerary ribs in rodents: role of the maternal stress.

Increased incidences of supernumerary ribs (SNR) are a relatively common finding in standard teratology bioassays, and previous studies have indicated a possible correlation between their occurrence and general maternal stress. The present study describes the effects of immobilization stress on the induction of supernumerary ribs. To isolate the sensitive period of SNR induction, Sprague-Dawley rats and CD-1 mice were treated with 300 and 1,500 mg/kg, respectively, of sodium salicylate on single days 7-11 of gestation. In the rat, day 10 was found to be the sensitive period of lumbar rib induction (32% SNR vs 10% on other days) while day 9 was critical in the mouse (71% SNR vs less than 29% on other days). In a second set of experiments, maternal stress was accomplished by restraining two groups of gravid females in the supine position for 12 hours on the predetermined sensitive day. One group was immobilized from 9 am to 9 pm, while the second group was restrained from 9 pm to 9 am. Concurrent controls were food and water deprived for similar periods. Additional untreated controls were also included. An increase in supernumerary ribs was noted in stressed mice but not in rats. The 9 am to 9 pm mouse group exhibited the highest increase in supernumerary ribs (41%) as well as significant incidences of fused ribs and exencephaly. A significant linear relationship between maternal weight loss during treatment and increases in supernumerary ribs was also noted. Results suggest that for some compounds, supernumerary ribs may be the indirect result of agent-induced, generalized maternal stress in the CD-1 mouse.

Animals↗
PubMed2001

Length of the ribs in patients with idiopathic scoliosis.

There have been few reports of actual measurements of rib length in patients with idiopathic scoliosis. We measured the lengths of the 7th to 12th ribs in 28 patients with idiopathic scoliosis with right convex single thoracic curve. The measurements were performed by the multi-projection volume reconstruction method of computed tomography. A significant difference between the left and right side length (laterality) was observed in the 11th and 12th ribs. Laterality was not observed in the 7th, 8th, 9th, and 10th ribs. In this study, it appeared inadequate to conclude that the laterality of rib length caused the scoliosis. Since the 11th and 12th ribs were floating ribs, we speculated that, on the contrary, the scoliosis affected the laterality of the rib length.

Adolescent↗
PubMed2003

Rib deformity in scoliosis.

Rib deformity in scoliosis is of interest because it may help in the diagnosis, and also, in some pronounced cases, it may need correction by costoplasty. There are, however, debates about its use in diagnosis, because some authors think that rib deformity is not closely related to either the magnitude or the extent of rotation of the curve. In order to define the relation between rib deformity and scoliosis, 11 patients were recruited who were to undergo scoliosis surgery and thoracoplasty, and anteroposterior (AP) T1-S1 standing radiographs, computerized tomography (CT) scans, and three-dimensional (3D) reconstructions were obtained. From the radiographs, the most rotated vertebra, the Cobb angle, the apex and the type of the curve were determined. From the CT scans and 3D reconstructions, the exact level of the rib deformity measured was matched with the corresponding vertebral level. In this way, the most rotated vertebra and the most prominent part of the rib cage deformity were identified. The most rotated vertebra was found to be at the same level in both radiographs and CT scans in only five patients. In the rest of the patients, CT scans showed it either one level higher or lower than it appeared on the radiograph. The most prominent part of the rib cage deformity was at the same level as the most rotated vertebra in two patients, and in the rest of the patients it was one, two or three vertebral levels lower. There was no association between the Cobb angle, vertebral rotation and rib deformity. A CT scan is necessary preoperatively in patients who will undergo a costoplasty, to determine the exact levels of the prominence. However, a scanogram or a 3D reconstruction is required for exactly matching the most prominent part of the rib cage deformity to the corresponding vertebral level.

Adolescent↗
PubMed2006

Does cardiopulmonary resuscitation cause rib fractures in children? A systematic review.

BACKGROUND: There is a diagnostic dilemma when a child presents with rib fractures after cardiopulmonary resuscitation (CPR) where child abuse is suspected as the cause of collapse. We have performed a systematic review to establish the evidence base for the following questions: (i) Does cardiopulmonary resuscitation cause rib fractures in children? (ii) If so, what are the frequency and characteristics of these fractures that may help to distinguish them from rib fractures caused by physical abuse? METHODS: We performed a literature search of original articles, references, textbooks, and conference abstracts, published in any language from 1950 to 1 October 2005. Articles were identified from ASSIA, Caredata, Medline, Ovid Medline in Process, ChildData, CINAHL, Embase, ISI Proceedings, SIGLE, Science Citation Index, Social Science Citation Index, and TRIP databases. We included all studies that addressed rib fractures and CPR in children less than 18 years, and excluded review articles, expert opinion, consensus guidelines, and studies that were significantly methodologically flawed on critical appraisal. Each study underwent two independent reviews (with a third review if there was disagreement). Each reviewer used standardized criteria for study definition, data extraction, and critical appraisal, to determine the quality of the study and to establish if it met the inclusion criteria of this systematic review. FINDINGS: Of the 427 studies reviewed, 6 were included: 1 case control, 4 cross-sectional, and 1 case series. These represent data on 923 children who underwent CPR. Three children sustained rib fractures as a result of resuscitation; all three of these had fractures that were anterior (two mid-clavicular and one costo-chondral). We did not find any child in the literature who had a posterior rib fracture due to CPR. Resuscitation was performed variably by both medical and non-medical personnel. CONCLUSION: Rib fractures after cardiopulmonary resuscitation are rare. When they do occur, they are anterior and may be multiple. As the studies performed to date did not use the most sensitive techniques for detecting rib fractures, further prospective studies of children would be valuable to provide additional clarification on this question.

Adolescent↗
PubMed2006

The use of a segmented transducer for rib sparing in HIFU treatments.

The use of focused ultrasound as a minimally invasive treatment for tumours is rapidly expanding. Target organs include the liver and kidneys. Both single element and phased array transducers may be used in the clinic. The presence of the rib cage presents a problem in high intensity focused ultrasound (HIFU) treatment planning, due to its high attenuation of the HIFU beam resulting in a loss of power at the focus as well as an increase in the risk of damage at the rib and to overlying tissues, including the skin. In this paper, a linearly segmented transducer, in which all active elements are driven in phase, has been investigated. The aim of the study was to investigate how a beam with a clinically useful profile could be achieved by removing the contribution of edge segments from one side of the transducer to the field. We have considered the case in which the HIFU beam approaches the rib cage during a treatment and investigated configurations of the transducer for which up to three segments on the edge are switched off. This problem has been studied initially using a linear acoustic field program to model the segmented transducer's acoustic beam profile. Experimental measurements of the transducer's acoustic field were performed using an automated beam plotting system. Temperature measurements were made on a rib surface for two transducer configurations using a fine wire thermocouple. A thermochromic liquid crystal material was used to assess qualitatively the heating pattern generated by the ultrasound beam. We show the rib sparing potential of the segmented transducer during HIFU treatment by demonstrating a reduction in the prefocal width of the ultrasound beam when edge segments are switched off. This has been predicted with the acoustic field model and demonstrated experimentally by acoustic field measurements and observations of the heating pattern generated by the ultrasound beam. A significant decrease in the temperature rise on a rib was observed in the case for which three edge segments were switched off compared with when all segments were active. We conclude that a segmented transducer extends the potential for treating liver tumours. In the case where the tumour lies behind, but close to the edge of, the ribs, energy loss at the focus and excessive heating in the rib and overlying tissue can be avoided by switching off edge segments.

Acoustics↗
PubMed1997

Traumatic first rib fracture: is angiography necessary? A review of 730 cases.

The two most common sites of first rib fracture were at the subclavian sulcus and in the neck of the first rib, posteriorly. Five distinct mechanisms for rib fracture were identified and included: (i) posteriorly directed trauma to the upper thorax or shoulder girdle; (ii) a direct blow to the sternum and anterior chest wall; (iii) a blow fracturing the clavicle; (iv) a strong sudden contraction of the scalenus anticus muscle; and (v) radiographic findings of a first rib fracture without history of trauma. Isolated first rib fracture regardless of mechanism of injury, results in a low incidence of major vascular injury (mean 3%), although with fracture displacement, the incidence is higher. First rib fracture associated with concomitant head, thoracic, abdominal, or long bone trauma was associated with vascular injury in 24% of cases. According to this review, specific indications for subclavian artery and aortic arch arteriography in patients with traumatic first rib fracture include widened mediastinum on chest radiography, upper-extremity pulse deficit, posteriorly displaced first rib fracture, subclavian groove fracture anteriorly, brachial plexus injury and expanding hematoma.

Angiography↗
PubMed1999

Diagnostic issues in tuberculosis of the ribs with a review of 12 surgically proven cases.

The ribs and surrounding chest wall are uncommon sites of tuberculosis (TB). Tuberculosis of the rib bone is often delayed in diagnosis or is recurrent with medical treatment. Rib TB is often negative or shows nodular shadows which is mimicking a metastatic tumour. We reviewed 12 cases of rib TB, which were confirmed by surgical rib resection. The most common reason given for attending the hospital was palpation of the chest wall mass, the onset of chest pain or draining sinus on the chest wall. The correct diagnosis was often delayed due to misdiagnosis of the other conditions. The misdiagnosis was produced from vague symptoms and various radiological features of rib TB. Occasionally, previous TB history could provide an indication of rib TB. Occasionally, their pre-operative diagnostic processes were inadequate and were not consistent depending on the physician. From these reviews, we attempted to reconstruct the best diagnostic and therapeutic modalities. Our recommendation for detecting rib TB is an accurate medical history and physical examination, and early differential diagnosis with bone scintigram, computed tomogram, and percutaneous needle biopsy. Surgery can be a final diagnostic option for differential diagnosis or in a therapeutic role for recalcitrant or complicated cases.

Adolescent↗
PubMed2004

Biosorbable poly-L-lactide rib-connecting pins may reduce acute pain after thoracotomy.

OBJECTIVE: Conventional thoracotomy is currently used as a standard procedure, and is often required to treat numerous diseases. Additionally, rib resections are occasionally required to maintain an adequate field of view for surgery. The benefits of using rib pins for chest closure following such procedures have not yet been established. This study sought to evaluate the usefulness of rib pins in reducing acute postoperative pain. METHODS: Thirty-three consecutive patients with lung cancer underwent lobectomies using the posterolateral approach. The patients were rib-resected and reconstructed with two techniques: 21 patients with absorbable rib pins (ARP group) and 12 patients by ligation with absorbable sutures (LAS group). Intensity of pain was assessed during the 3 days immediately following surgery. The two groups were assessed using the visual analogue scale (VAS) as a pain scale, amounts consumed of patient-controlled analgesics (PCA), and additional chest x-rays. RESULTS: On the first day following surgery, the mean VAS intensity of the ARP group for patient motion was 2.71 +/- 2.14, compared to 5.33 +/- 2.99 in the LAS group. After three days, the mean score for the ARP group was 1.98 +/- 1.89, compared to 4.60 +/- 1.97 in the LAS group. Scores in the ARP group were significantly lower than in the LAS group one day and three days following thoracotomy. The LAS group (55.0 +/- 15.9 times) made more frequent requests than the ARP group (16.1 +/- 10.3 times). The PCA requirement was also significantly lower in the ARP group. Excessive derangement of the rib (grade 2) was found in one case (4.7 %) in the ARP group compared to five cases (41.6 %) in the LAS group. Rib shifts were seen in numerous cases in the LAS group compared to the ARP group as measured by chest x-rays. CONCLUSIONS: Use of absorbable rib pins reduced postoperative pain and may improve long-term prospects for the post-thoracotomy course.

Acute Disease↗
PubMed1990

Three or more rib fractures as an indicator for transfer to a Level I trauma center: a population-based study.

UNLABELLED: The presence of major chest wall injury is an indication for transfer to a Level I trauma center. We hypothesized that the presence of three or more rib fractures on initial chest X-ray would identify a small subgroup of patients with a high probability of requiring trauma center care. All trauma discharges in Maryland between 1984 and 1986 (N = 105,683) were reviewed. Patients were divided by the presence of rib fractures (no rib fractures, 1-2 fractures, 3+ fractures) and age in years (0-13, 14-64, 65+). RESULTS: The presence of three or more rib fractures in the pediatric age group was rare and precluded further evaluation. When comparing patients with 1-2 rib fractures versus 3 or more rib fractures, significant differences were found in mortality, mean Injury Severity Score, mean hospital stay and mean number of ICU days (p less than 0.001). The significant differences occurred in all age groups 14 years old and older. The presence of three or more rib fractures increased the relative risk of splenic injury (6.2) and liver injury (3.6) but did not predict the presence of aortic injury. CONCLUSION: The presence of 3 or more rib fractures identifies a small subgroup of patients (2.4%) likely to require tertiary care. This triage tool is useful in all patients over the age of 14 years.

Adolescent↗
PubMed1996

Biomechanical role of the posterior elements, costovertebral joints, and rib cage in the stability of the thoracic spine.

STUDY DESIGN: This is a biomechanical study of the thoracic spine. Various ligaments and joints were resected sequentially and nondestructive cyclic loading tests were performed. Effects of each resection were analyzed biomechanically. OBJECTIVES: To investigate the role of the posterior elements, costovertebral joints, and rib cage in the stability of the thoracic spine. SUMMARY OF BACKGROUND DATA: There have been no experimental studies concerning the mechanical interaction between the thoracic spine and rib cage. METHODS: Eight canine rib cage-thoracic spine complexes, consisting of the sixth to eighth ribs, sternum, and T5-T9 vertebrae, were used. Six pure moments along three axes were applied to the specimens, and angular deformation of T6-T7 was recorded. After testing the intact specimen, resection of the stabilizers was conducted incrementally in the following manner: 1) removal of the posterior elements at T6-T7, 2) resection of the bilateral seventh costovertebral joints, and finally, 3) destruction of the rib cage. The same loading tests were repeated at each stage. The ranges of motion and neutral zones were calculated by digitization. RESULTS: A large increase in the range of motion in flexion-extension was observed after resection of the posterior elements and in lateral bending and axial rotation after resection of the costovertebral joints. A significant increase in the neutral zone in lateral bending and axial rotation was observed after bilateral resection of the costovertebral joints and destruction of the rib cage. CONCLUSIONS: The costovertebral joints and rib cage play an important role in providing stability to the thoracic spine. The state of the costovertebral joints and rib cage should be assessed to evaluate the stability of the thoracic spine.

Animals↗