Respiratory failure in postpneumonectomy syndrome complicated by thoracic lordoscoliosis: treatment with prosthetic implants, partial vertebrectomies, and spinal fusion.
METHODS
This study investigated the case of a 17-year-old girl with postpneumonectomy syndrome, complicated by a thoracic lordoscoliosis, who was successfully treated with prosthetic implants, partial vertebrectomies, and anteroposterior spinal fusion.


OBJECTIVE
To report a unique case and describe the authors' method of treatment.


BACKGROUND
Postpneumonectomy syndrome is an uncommon complication of pneumonectomy. Many case reports describe successful treatment with insertion of prosthetic implants into the empty hemithorax to shift the mediastinum to its original position. Thoracic lordoscoliosis reportedly has contributed to pulmonary compromise, but no cases have shown its occurrence in the setting of postpneumonectomy syndrome.


METHODS
The patient was observed at the National Children's Hospital in Tokyo, referred to Children's Hospital in Los Angeles, California for surgical correction, and followed in Tokyo for the next year.


RESULTS
Two prosthetic implants with an injection port for further expansion were positioned in the right hemithorax to restore the mediastinum to its normal position. Anterior discectomies, partial vertebrectomies, and fusion of T5-T10 was performed concurrently. Then 5 days later, posterior spinal fusion of T1-T12 with instrumentation and bone graft were performed to correct the thoracic lordoscoliosis and increase the chest cavity space. At 1 month after the surgery, the patient was extubated after being ventilator dependent for 5 months. At the time of operation, the girl was ventilator dependent and nonambulatory, but 1 year later could participate in all activities of daily living without any oxygen supplementation.


CONCLUSIONS
Postpneumonectomy syndrome can be treated successfully with prosthetic implants to restore the normal position of the mediastinum. Thoracic lordoscoliosis can complicate the syndrome and may be corrected to help restore normal pulmonary function.
Codsi
M J
MJ
Division of Orthopaedics, Childrens Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles California 90020, USA.
Keens
T G
TG
Stein
J E
JE
Miyasaka
K
K
Skaggs
D L
DL
D000293:Adolescent; D001672:Biocompatible Materials; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008141:Lordosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D011013:Pneumonectomy / Q000009:adverse effects*; D019736:Prostheses and Implants; D019919:Prosthesis Implantation; D012129:Respiratory Function Tests; D012131:Respiratory Insufficiency / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D012600:Scoliosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D013123:Spinal Fusion / Q000379:methods*; D013577:Syndrome; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery; D014057:Tomography, X-Ray Computed
D001672:Biocompatible Materials