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Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2022)

25. - 28.10.2022, Berlin

Thoracogenic scoliosis. A retrospective review of 129 pediatric patients with a mean follow-up of 10 years

Meeting Abstract

  • presenting/speaker Riccardo Sacco - Centre Hospitalier Universitaire de Roeun, Rouen, France
  • Eric Nectoux - Hôpital Jeanne de Flandre, Lille, France
  • Mourad Ould Slimane - Centre Hospitalier Universitaire de Roeun, Rouen, France
  • Federico Canavese - Hôpital Jeanne de Flandre, Lille, France

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2022). Berlin, 25.-28.10.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocAB80-942

doi: 10.3205/22dkou653, urn:nbn:de:0183-22dkou6533

Veröffentlicht: 25. Oktober 2022

© 2022 Sacco et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objectives: To determine the mid-term outcome of lateral thoracotomy (LT) in skeletally immature patients with regard to thoracogenic scoliosis development, and to evaluate the influence of associated lung parenchyma resection (LPR) procedures.

Methods: A total of 129 patients met the following inclusion criteria: 1) LT during the study period; 2) skeletally immature at the time of LT; 3) clinical and radiographic follow-up of at least 3 years; 4) no spinal or thoracic deformity on radiographs prior to the surgical index procedure. Patients were grouped according to the underlying disease, age at LT, and extent of LPR. Cobb angle, rib-vertebral angle difference (RVAD), and vertebral rotation were assessed. Kaplan-Meier method, and univariate and multivariate analysis using logistic regression of risk factors for thoracogenic scoliosis were performed. The end-point was set at the conclusion of the observation period, at the time of the last follow-up available for each patient.

Results and conclusion: A total of 108/129 patients underwent pneumonectomy (9; 9.1%), lobectomy (79; 61.2%), or segmentectomy (20; 15.5%); the remaining 21 patients underwent LT without LPR. The mean age at LT and at last radiological follow-up was 5.5 years (birth-17.8) and 15.2 years (3.4-33.2), respectively. The mean follow-up time was 10 years (3-28.1). Scoliosis developed on average 5.3 years after LT. The mean Cobb angle was 22.1° (11°-90°); it was > 10° in 37/129 patients (28.7%); >20° in 14/129 patients (10.8%) which required brace treatment for progressive deformity, and >45° in 5/129 patients (3.9%) which underwent posterior instrumented fusion. The average vertebral rotation was 16.2° (2°-43°; grade 0- II). RVAD was 26.5° (8°-33°) and 15.3° (2°-43°) in patients with Cobb > 45° and < =45°, respectively. Gender, age at surgery, and extent of LPR were not risk factors for post-thoracotomy scoliosis (p> 0.05), although younger patients developed a more severe deformity with significant progression at 9-10 years of age. The results of the overall cohort were confirmed in the group with at least 15 years of follow-up (28/129; 19.4%), of whom 10/28 developed scoliosis (35.7%) with a mean Cobb angle of 22.8°

Although thoracogenic scoliosis is not associated with significant rotation, the risk of curve progression > 45° is relatively high. In addition, brace treatment is associated with a high failure rate in patients with progressive deformity. Families of children undergoing LT should be informed about the mid-term risk of scoliosis development. Regular follow-up is required as scoliosis may develop several years after LT, with or without LPR.