Thoracogenic Spinal Deformity: A Rare Cause of Early Onset Scoliosis

Abstract

Object:

Surgery for severe congenital defects such as congenital diaphragmatic hernia, congenital heart defects, and tracheoesophageal disorders are life-saving treatments for many infants. However, the incidence of scoliosis following thoracoabdominal surgery ranges from 8­50%. There is little known about severe scoliosis acquired following surgery in infancy. We sought to evaluate patients who developed severe scoliosis following surgical treatment of congenital conditions.

Methods:

A multicenter database of patients with early onset scoliosis was queried to identify patients with a history of thoracogenic or acquired scoliosis. Patients with significant congenital spine deformities were excluded. 41 patients (1.6%) were noted to have thoracogenic scoliosis. Of those, 14 were observed, 10 were casted or braced, 17 underwent treatment with rib-based distraction rods, Shilla, or spine-based growing rod devices. Radiographs, complications, and patient characteristics were reviewed.

Results:

Mean age at scoliosis diagnosis for the 41 patients was 6.0 years. Mean time to follow-up was 2.9 years. Mean preoperative coronal Cobb angle in the surgical group was 65° and improved to 47° postoperatively ( p=0.01). Mean Cobb angle for the non-operative group was 31° initially and 32° at follow-up (p=0.44). Among the 17 patients undergoing surgery for scoliosis, there were 13 complications in 7 patients, including a brachial plexus palsy following rib-based distraction rod placement. This resolved with revision of the rib hooks. There were no known complications in the non-operative cohort.

Conclusions:

Severe scoliosis can develop following thoracotomy and other pediatric surgical procedures. Work is needed to understand the pathogenesis of scoliosis in this population so as to implement preventative measures.

Level of Evidence:

IV, retrospective review of prospectively collected data