Is expansion thoracoplasty a safe procedure for mobility and growth potential of the spine? Spontaneous fusion after multiple chest distractions in young children.
BACKGROUND
Expansion thoracoplasty (ET) is claimed to be a spine-sparing procedure because of the fact that the spine is not exposed directly and intervention toward the spinal column is not performed. It is also recommended in cases of primary spine deformities without rib fusion/aplasia and when the primary problem is not in the thorax itself. The aim of this study was to report spontaneous spinal fusion after multiple thoracic distractions in patients with congenital thoracospinal deformities who have undergone ET in early childhood.


METHODS
In our clinic, between May 2003 and March 2010, ET treatment was started in 11 patients who had congenital spinal deformity along with thoracic asymmetry due to fused ribs. The lengthening procedures for 6 of them are still ongoing. This study includes 5 of these patients who had undergone 3-dimensional computed tomography (3D-CT) scans. Four of these patients underwent a CT scan as part of the graduation protocol and 1 was ordered a 3D-CT because a newly formed bony fusion of the ribs was observed in a lengthening procedure.


RESULTS
The mean age of the patients (4 F, 1 M) was 4.2 years (range, 2 to 8 y) at the time of the index operation. The mean number of lengthening procedures was 9.4 (range, 7 to 13). The mean follow-up period was 73 months (range, 60 to 96 mo). All 5 patients in the latest follow-up were evaluated by x-ray and 3D-CT scans of the whole spine. The CT scans confirmed spontaneous spinal fusion in the thoracic spine.


CONCLUSIONS
We speculate that distraction-based, growth-friendly instrumentations are not risk-free for spinal health and motion, even when the instrumentation is not primarily on the spine.


METHODS
Level IV.
Department of Orthopaedics, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
Caglar
C
Yilgor
Gokhan
G
Demirkiran
Mehmet
M
Ayvaz
Muharrem
M
Yazici
D001852:Bone Lengthening / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D012189:Retrospective Studies; D012272:Ribs / Q000002:abnormalities / Q000601:surgery*; D012600:Scoliosis / Q000151:congenital / Q000503:physiopathology / Q000601:surgery; D013122:Spinal Diseases / Q000151:congenital / Q000503:physiopathology / Q000601:surgery*; D013131:Spine / Q000254:growth & development / Q000503:physiopathology; D013904:Thoracic Vertebrae; D013905:Thoracoplasty / Q000009:adverse effects / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods