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. 2022 Nov-Dec;42(10):558-563.
doi: 10.1097/BPO.0000000000002229. Epub 2022 Aug 25.

Curve Characteristics and Surgical Outcomes in Scoliosis Associated With Childhood Sternotomy or Thoracotomy

Joanna L Langner  1 , Teeto Ezeonu  1 , Abdul-Lateef Shafau  1 , Nadine Javier  1 , Xochitl Bryson  1 , Japsimran Kaur  1 , Kiley Poppino  2 , Claire Shivers  2 , Sai Chilakapati  2 , Kimberly E Hall  1 , Meghan N Imrie  1   3 , Lawrence Rinsky  1   3 , Anthony I Riccio  2 , John S Vorhies  1   3
Affiliations

Curve Characteristics and Surgical Outcomes in Scoliosis Associated With Childhood Sternotomy or Thoracotomy

Joanna L Langner et al. J Pediatr Orthop. 2022 Nov-Dec.

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.

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Conflict of interest statement

J.S.V. receives grant funding from the Scoliosis Research Society (SRS), Pediatric Orthopaedic Surgery of North America (POSNA), and Stanford University. J.S.V. is a consultant for Ortho Pediatrics, and a committee member of the SRS Research Grant Committee and POSNA’s Industry Relations Committee and Research Committee, and a former member of the POSNA Evidence-Based Practice committee. M.N.I. is on the ICL committee chair for the American Academy of Orthopaedic Surgeons (AAOS) and a fellowship committee member for POSNA. Dr. Anthony I Riccio receives royalties for chapter authorship from Elsevier, is an honoraria for Industry Sponsored Educational Symposium at The European Paediatric Orthopaedic Society annual meeting, received travel support from the Orthopaedic Trauma Association for directing the Comprehensive Resident Fracture Course Pediatric Trauma Module (2019/2018, is a member of the board of directors for the Children’s Orthopaedic Trauma and Infection Consortium for Evidence Based Studies, and receives medical equipment donations for investigational initiated research from Arthrx. L.R. received payment for expert testimony of legal documents before 2019. The remaining authors declare no conflicts of interest.

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