title: Scoliosis after median sternotomy in children with congenital heart disease.
abstract: METHODS
  A retrospective review of spinal deformity in patients with congenital heart disease surgically treated through a median sternotomy before the age of 8 years. Assessment was done on chest roentgenograms at skeletal maturity.
  
  
  OBJECTIVE
  To determine if patients surgically treated through a median sternotomy present a higher prevalence of spinal deformity.
  
  
  BACKGROUND
  Congenital heart disease is associated with a higher prevalence of scoliosis. The etiology of scoliosis in this group of patients is unknown. Thoracotomy causes scoliosis, but median sternotomy has not been identified as a causal agent in these patients.
  
  
  METHODS
  Chest roentgenograms were done after skeletal maturity in 128 patients to assess for the presence of a spinal deformity in the sagittal or coronal plane as a result of a median sternotomy for treatment of congenital heart disease before the age of 8 years in patients without any prior radiographic evidence of spinal or costal deformity before surgery.
  
  
  RESULTS
  Forty-four (34.3%) of these patients had scoliosis greater than 10 degrees , 16 of them (12.5%) had curves greater than 20 degrees , and 33 (25.8%) had thoracic kyphosis lesser than 20 degrees . Patients operated before the age of 18 months had a significantly increased risk of developing scoliosis than those operated at a later age (odds ratio = 3.5; confidence interval = 1.3-9.6; P = 0.016). The presence of scoliosis was not related to the type of congenital heart disease.
  
  
  CONCLUSIONS
  There is a high prevalence of scoliosis in patients with congenital heart disease surgically treated through a median sternotomy. The prevalence of scoliosis increases in patients operated at an earlier age.
authors.affiliation: Departamento de Cirugía Ortopédica y Traumatología, Hospital Ramón y Cajal, Madrid, Spain. drmri@hotmail.com
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Ruiz-Iban
authors.forename: Jesus
authors.initials: J
authors.lastname: Burgos
authors.forename: Hector J
authors.initials: HJ
authors.lastname: Aguado
authors.forename: Jorge
authors.initials: J
authors.lastname: Diaz-Heredia
authors.forename: Ignacio
authors.initials: I
authors.lastname: Roger
authors.forename: Alfonso
authors.initials: A
authors.lastname: Muriel
authors.forename: Pedro A
authors.initials: PA
authors.lastname: Sanchez
mesh_terms: D000293:Adolescent; D000328:Adult; D000375:Aging; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007738:Kyphosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology; D008297:Male; D015995:Prevalence; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D013249:Sternum / Q000601:surgery*