Curve Characteristics and Surgical Outcomes in Scoliosis Associated With Childhood Sternotomy or Thoracotomy. Issue 10 (25th November 2022)

• Record Type: Journal Article
• Authors: Langner, Joanna L.; Ezeonu, Teeto; Shafau, Abdul-Lateef; Javier, Nadine; Bryson, Xochitl; Kaur, Japsimran; Poppino, Kiley; Shivers, Claire; Chilakapati, Sai; Hall, Kimberly E.; Imrie, Meghan N.; Rinsky, Lawrence; Riccio, Anthony I.; Vorhies, John S.
• Is Part Of: Journal of pediatric orthopaedics. Volume 42:Issue 10(2022)
• Page Start: 558
• Page End: 563
• Publication Date: 2022-11-25
• Subjects: post-chest incision scoliosis -- sternotomy -- thoracotomy -- spinal fusion; Pediatric orthopedics -- Periodicals; 618.927
• DOI: 10.1097/BPO.0000000000002229
• Languages: English
• ISSNs: 0271-6798

Abstract

Abstract : Background: The purpose of this study is to describe curve characteristics and postoperative outcomes in patients undergoing spinal fusion (SF) to treat thoracogenic scoliosis related to sternotomy and/or thoracotomy as a growing child. Methods: A retrospective review of electronic medical records of all patients with Post-Chest Incision scoliosis treated with SF was performed at 2 tertiary care pediatric institutions over a 19-year period. Curve characteristics, inpatient, and outpatient postoperative outcomes are reported. Results: Thirty-nine patients (62% female) were identified. Eighteen had sternotomy alone, 14 had thoracotomy alone, and 7 had both. Mean age at the time of first chest wall surgery was 2.5 years (range: 1.0 d to 14.2 y). Eighty-five percent of patients had a main thoracic curve (mean major curve angle 72 degrees, range: 40 to 116 degrees) and 15% had a main lumbar curve (mean major curve angle 76 degrees, range: 59 to 83 degrees). Mean thoracic kyphosis was 40 degrees (range: 4 to 84 degrees). Mean age at the time of SF was 14 years (range: 8.2 to 19.9 y). Thirty-six patients had posterior fusions and 3 had combined anterior/posterior. Mean coronal curve correction measured at the first postoperative encounter was 53% (range: 9% to 78%). There were 5 (13%) neuromonitoring alerts and 2 (5%) patients with transient neurological deficits. Mean length of hospital stay was 9±13 days. At an average follow-up time of 3.1±2.4 years, 17 complications (10 medical and 7 surgical) were noted in 9 patients for an overall complication rate of 23%. There was 1 spinal reoperation in the cohort. 2/17 (12%) complications were Clavien–Dindo-Sink class III and 5/17 (29%) were class IV. Conclusion: Kyphotic thoracic curves predominate in patients with Post-Chest Incision scoliosis undergoing SF. Although good coronal and sagittal plane deformity can be expected after a fusion procedure, postoperative complications are not uncommon in medically complex patients, often necessitating longer postoperative stays. Level of Evidence: Level III.