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Journal of Children's Orthopaedics Apr 2024Hybrid techniques using thoracic sublaminar bands have proved their efficacy in adolescent idiopathic scoliosis posterior fusion, but clinical axial correction sometimes...
PURPOSE
Hybrid techniques using thoracic sublaminar bands have proved their efficacy in adolescent idiopathic scoliosis posterior fusion, but clinical axial correction sometimes remained disappointing. One solution found was "the frame technique" and the second alternative was the replacement of the convex sublaminar bands by periapical uniplanar screws. The goal of this study was to compare clinical and radiological outcomes of both techniques in a consecutive cohort of adolescent idiopathic scoliosis patients.
METHODS
All patients undergoing primary posterior fusion for thoracic adolescent idiopathic scoliosis between January 2017 and March 2020 were included. Two groups were compared: Group 1 with thoracic sublaminar bands only and Group 2 with periapical uniplanar screws. All patients underwent standing stereoradiographs. The main frontal, sagittal, and axial (apical vertebra rotation) radiological parameters of interest were analyzed. Functional outcomes were assessed using the Scoliosis Research Society 30 score.
RESULTS
A total of 147 adolescents were included (Group 1, n = 73 and Group 2, n = 74 patients). In the frontal plane, a greater reduction index was observed in Group 2 (68% versus 62%, p < 0.001) as well as a better apical axial correction (67.8% versus 46.6%, p = 0.03). The number of thoracoplasty performed was reduced (6.7% versus 20.5%, p = 0.02) in Group 2, with a significant decrease in the rate of mechanical complication. No significant loss of correction was observed during follow-up in any of the group.
CONCLUSION
The adjunction of convex uniplanar screws at the periapical levels improved the three-dimensional surgical correction of thoracic adolescent idiopathic scoliosis treated with hybrid constructs.
LEVEL OF EVIDENCE
level III, retrospective comparative study.
PubMed: 38567048
DOI: 10.1177/18632521231220388 -
International Medical Case Reports... 2024Poland syndrome is a rare congenital syndrome that is characterized by partial or complete unilateral absence of the pectoralis major muscle, congenital malformation of...
INTRODUCTION
Poland syndrome is a rare congenital syndrome that is characterized by partial or complete unilateral absence of the pectoralis major muscle, congenital malformation of the hand and deformation of the chest. Often the patients has abnormalities of the nipple-areolar complex. Here, we present a case of surgical treatment of local chest deformity with patient with Poland syndrome.
CASE PRESENTATION
We observed a patient, an 18-year-old man. The parents noticed the deformation of the chest from birth. The patient did not receive any treatment until adulthood. The patient contacted our clinical research center to correct chest deformity. After clinical and diagnostic procedures, the patient underwent surgical operation: open thoracoplasty with installation of a wire-frame construction. The early postoperative period was uneventful. Early postoperative outcome was assessed 6 months after surgery.
CONCLUSION
Our experience shows that thoracoplasty using a wire-frame construction is a good method for correcting local chest deformities in patients with Poland syndrome.
PubMed: 38562434
DOI: 10.2147/IMCRJ.S441944 -
Archivos Peruanos de Cardiologia Y... 2023We present the case of a two-year-old girl, with a history of pulmonary banding surgery who underwent a chest wall stabilization technique with titanium rods and muscle...
We present the case of a two-year-old girl, with a history of pulmonary banding surgery who underwent a chest wall stabilization technique with titanium rods and muscle flaps coverage, due to post-surgical mediastinitis associated with total sternal loss after ventricular septal defect closure surgery, debanding, and pulmonary artery plasty. The patient had a favorable postsurgical evolution.
PubMed: 38298413
DOI: 10.47487/apcyccv.v4i4.326 -
Journal of Orthopaedic Case Reports Jan 2024This case report abstract discusses scoliosis, a multifactorial three-dimensional spinal deformity, including lateral curvatures on the frontal plane characterized by...
INTRODUCTION
This case report abstract discusses scoliosis, a multifactorial three-dimensional spinal deformity, including lateral curvatures on the frontal plane characterized by Cobb angle measurement, vertebral rotation on the axial plane and sagittal deformity. Scoliosis can be mild, moderate, or severe, and if left untreated, it can lead to further deformity and compromise cardiopulmonary function. Scoliosis is classified into early onset and late onset, with idiopathic scoliosis being the most common form. Early-onset scoliosis has various etiologies, including idiopathic, congenital, neuromuscular, and syndromic. Early management is crucial to minimize complications, such as restrictive ventilatory disorder and pulmonary dysplasia. This case report focuses on an iatrogenic cause of scoliosis due to rib synostosis, which is not included in the classification. Treatment options include non-operative management and surgical interventions, with the use of vertical expandable prosthetic titanium rib (VEPTR) thoracoplasty to correct the spinal deformity.
CASE REPORT
This article illustrates the case of a 13-year-old girl who developed a left thoracic scoliosis caused by ribs fusion, following multiple right thoracotomies during childhood for esophageal atresia with tracheoesophageal fistula. No vertebral abnormalities were reported. Considering the young age of the girl, spinal fusion was not considered. A VEPTR associated with an excision of the fused ribs was used to treat this patient.
CONCLUSION
The aim of this article was to illustrate the importance of a regular follow-up for the patients who have undergone multiples thoracotomies during their childhood even without vertebral abnormalities and propose an early approach to avoid spinal fusion in early adulthood.
PubMed: 38292080
DOI: 10.13107/jocr.2024.v14.i01.4172 -
International Journal of Surgery Case... Feb 2024Despite the chance of a complete cure that surgery offers for patients seen early, the management of some complicated forms of chronic pyothorax with calcified pleural...
INTRODUCTION AND IMPORTANCE
Despite the chance of a complete cure that surgery offers for patients seen early, the management of some complicated forms of chronic pyothorax with calcified pleural pockets of tuberculosis origin is risky, if not impossible. In these conditions, thoracomyoplasty with complete effacement of the pleural pocket is an effective alternative in the surgical management of these pockets.
CASE PRESENTATION
We report the case of a 37-year-old male African Arab who was treated for a chronic, calcified pleural pocket of tuberculous origin and in whom low thoracomyoplasty was performed because of the impossibility of performing a left pleuropneumonectomy. The operating courses were uneventful with full pocket closures.
REVIEW
1 year later, the patient reported having resumed his active professional life.
CLINICAL DISCUSSION
Pleural decortication associated or not with a pulmonary resection is the main surgical procedure used to manage chronic pyothorax. However, this procedure remains difficult with the risk of death, if not impossible, in cases of long-term chronicity with calcification of the pleural poche wall. In these cases, thoracomyoplasty constitutes a viable alternative in the surgical management of these pleural pockets.
CONCLUSION
In the context of tuberculosis and chronic pleural empyema, thoracomyoplasty can be an alternative with satisfactory results when performed by an experienced team using this technique.
PubMed: 38262219
DOI: 10.1016/j.ijscr.2024.109295 -
Journal of Investigative Medicine High... 2023Tuberculous bronchopleural fistula (BPF) is a rare and potentially life-threatening complication of pulmonary tuberculosis, in which abnormal connections form between...
Tuberculous bronchopleural fistula (BPF) is a rare and potentially life-threatening complication of pulmonary tuberculosis, in which abnormal connections form between the bronchial tree and the pleural space. These abnormal connections allow air and secretions to pass from the lungs into the pleural space, causing a range of symptoms from benign cough to acute tension pneumothorax. The management of tuberculous BPF requires an individualized approach based on the patient's condition and response to treatment. Anti-tuberculosis therapy is essential for controlling the active tuberculosis infections. Intercostal drainage and suction are also commonly used to drain air and fluid from the pleural space, providing relief from the symptoms. For some patients, more invasive surgeries, such as decortication, thoracoplasty or pleuropneumonectomy are required to definitively close the fistula when medical management alone is insufficient. Herein, we describe a rare case of tuberculous BPF in a young adult female, who was treated with anti-tuberculosis medications and open thoracotomy.
Topics: Humans; Young Adult; Bronchial Fistula; Lung; Pleural Diseases; Pneumonectomy; Tuberculosis; Female; Antitubercular Agents
PubMed: 38130119
DOI: 10.1177/23247096231220466 -
Acta Medica Portuguesa Dec 2023
Topics: Humans; Noninvasive Ventilation; Tuberculosis, Pulmonary; Respiration, Artificial; Thoracoplasty; Collapse Therapy
PubMed: 38048686
DOI: 10.20344/amp.20611 -
Orthopaedic Surgery Jan 2024The treatment of scoliosis with a severe rib hump remains a major challenge. Traditional vertebral rotation techniques are not satisfactory, and thoracoplasty has many...
OBJECTIVES
The treatment of scoliosis with a severe rib hump remains a major challenge. Traditional vertebral rotation techniques are not satisfactory, and thoracoplasty has many pulmonary complications that limit its application. A novel surgical device, the multiple screw distraction reducer (MSDR) system, provides longitudinal distraction during the corrective operation while at the same time providing lateral translation and axial derotation, which may facilitate the correction of a rib hump. This study was performed to investigate the effectiveness of the MSDR system for adolescent idiopathic scoliosis (AIS) with a severe rib hump.
METHODS
This was a case-matched study of patients with retrospectively collected data from our hospital between January 2017 and December 2021. Sixty-eight patients who underwent one-stage posterior pedicle screw-instrumented spinal fusion were matched by the Cobb angle of the main curve and rib hump. All patients underwent a minimum of 2 years of follow-up. The patients were divided into two groups: the MSDR group (using the MSDR system, n = 34) and the DVR group (using direct vertebral derotation, n = 34). The patients were evaluated for the height of the rib hump, deformity correction, complications, and SRS-30 scores. The unpaired Student's t-test and Pearson's χ -test were used to compare the outcome measures between the two groups. Multiple linear regression analysis was used to examine the variables that affected the correction of a rib hump.
RESULTS
The rib hump was 30.21 ± 6.21 mm versus 29.35 ± 6.52 mm (p = 0.583) preoperatively and 9.18 ± 4.06 mm versus 13.82 ± 5.54 mm (p < 0.001) at the last follow-up in the MSDR and DVR groups, respectively. The correction rates were 70.83% and 53.56%, respectively (p < 0.001). Preoperatively, the main thoracic curve was 58.43° ± 7.97° and 57.84° ± 6.32° (p = 0.736) and was corrected to 10.92° ± 5.47° and 19.14° ± 5.32° (p < 0.001) at last follow-up in the MSDR and DVR group, respectively. Thoracic kyphosis was restored from 18.24° ± 5.19° and 17.98° ± 5.28° (p = 0.836) in the MSDR and DVR group to 24.59° ± 4.41° and 19.32° ± 4.96° (p < 0.001), respectively. Correction of apical vertebra rotation and translation in the main thoracic curve were significantly better in the MSDR group than in the DVR group (p < 0.05). There was no significant difference in the Lenke type, implant density, estimated blood loss, or follow-up duration between the two groups, whereas the operation time in the DVR group was significantly less than that in the MSDR group. There were only two minor pulmonary complications in the MSDR group. At the last follow-up, the MSDR group scored higher in terms of appearance and satisfaction (p < 0.05).
CONCLUSION
The MSDR system, enabling better coronal alignment, thoracic kyphosis, and axial derotation, could be a safe and effective technique for severe rib hump correction in AIS.
Topics: Adolescent; Humans; Scoliosis; Retrospective Studies; Thoracic Vertebrae; Treatment Outcome; Radiography; Pedicle Screws; Kyphosis; Spinal Fusion; Ribs
PubMed: 38010853
DOI: 10.1111/os.13943 -
Journal of Cardiothoracic Surgery Nov 2023Intrathoracic neurogenic tumors arise from sympathetic nerve trunks and intercostal nerves; more than 90% are benign. Schwannomas are the most common histological...
BACKGROUND
Intrathoracic neurogenic tumors arise from sympathetic nerve trunks and intercostal nerves; more than 90% are benign. Schwannomas are the most common histological variety, but fatalities due to giant schwannomas are rare.
CASE PRESENTATION
We report a case of a 65-year-old woman who presented with chest pain and cough. Computed tomography (CT) revealed a large left chest wall mass of 130-mm in size, and the patient was referred to our department. Tumor biopsy was performed under local anesthesia, and a diagnosis of schwannoma was made. Ten years previously, a 30-mm tumor had been noted in the left third intercostal space by a previous doctor, but follow-up had been interrupted owing to depressive disorder. Although we planned to perform intercostal artery embolization followed by chest wall tumor resection, the patient did not consent to surgery due to uncontrolled depression. After four months, she developed respiratory failure caused by compression due to an enlarged tumor and died. Autopsy also revealed a benign schwannoma with no malignant findings.
CONCLUSIONS
Although schwannomas are benign tumors, there are some very rare cases in which they can become huge and life-threatening. Therefore, a benign tumor should not be neglected, and if surgery is not possible at the time of diagnosis, a regular follow up is necessary, in order not to miss the right timing for surgery.
Topics: Female; Humans; Aged; Neurilemmoma; Thoracic Neoplasms; Tomography, X-Ray Computed; Thoracic Wall; Thoracoplasty
PubMed: 37964272
DOI: 10.1186/s13019-023-02375-2 -
Multimedia Manual of Cardiothoracic... Nov 2023This patient presented with a stage IIIB advanced lung cancer with chest wall invasion. She was treated with neoadjuvant chemoradiation therapy and had an excellent...
This patient presented with a stage IIIB advanced lung cancer with chest wall invasion. She was treated with neoadjuvant chemoradiation therapy and had an excellent treatment response. The management of T3N2 disease is controversial, but given her treatment response and age, she was discussed by the multidisciplinary tumour board and referred for surgical evaluation. She was offered a robotic en bloc lobectomy and chest wall dissection.
Topics: Female; Humans; Thoracic Wall; Neoadjuvant Therapy; Robotic Surgical Procedures; Lung Neoplasms; Thoracoplasty
PubMed: 37921749
DOI: 10.1510/mmcts.2023.051