title: Evaluation of thoracic factors after scoliosis surgery in patients with both scoliosis and pectus excavatum.
abstract: Pectus excavatum can negatively impact cardiac function during scoliosis surgery. Several authors reported severe hypotension associated with the prone position during scoliosis surgery in children that had both scoliosis and pectus excavatum. However, we could find no studies that evaluated the change in the thoracic factors, such as sternal tilt angle and Haller index after scoliosis surgery in patients with both scoliosis and pectus excavatum. The purpose of this study is to evaluate the change in thoracic factors after surgical treatment for scoliosis associated with pectus excavatum.
  
  
  
  We performed a retrospective review on 20 patients (10 males and 10 females) who underwent surgical treatment for scoliosis associated with pectus excavatum from August 2004 to April 2014 in our hospital. We investigated the scoliosis diagnosis, preoperative and postoperative Cobb and thoracic kyphosis (TK) angles, the change in TK after surgery and thoracic factors, including the AP and transverse diameters of the chest, the sternal tilt angle, and Haller index.
  
  
  
  Patient mean age was 13.2 years old (4-27 years old) at surgery. Types of scoliosis were idiopathic in 8 patients, syndromic in 10, and neuromuscular in 2. The mean Cobb angles were 72.1° preoperatively and 19.0° postoperatively. Curve locations were thoracic in 13 patients, thoracolumbar in 4, and lumbar in 3. Surgical treatment of pectus excavatum was performed in 9 patients (45 %) before scoliosis treatment. Mean sternal tilt angles were 11.5° preoperatively and 11.1° postoperatively. Mean Haller indices were 4.8 preoperatively and 5.3 postoperatively. This was especially true for syndromic or neuromuscular scoliosis and thoracolumbar/lumbar curve type patients in which scoliosis surgery tended to worsen the Haller index.
  
  
  
  The Haller index increased postoperatively in 11 of 20 patients, which means sternal depression deteriorated after scoliosis surgery in about 50 % of patients. We suggest that surgeons fully assess the thoracic factors in patients with scoliosis and pectus excavatum prior to performing scoliosis surgery and carefully monitor their patient's general condition during surgery.
authors: Department of Orthopaedics and Spine Surgery, Meijo Hospital, 1-3-1, Sannomaru, Naka-ku, Nagoya, 460-0001, Japan.
authors: Ryoji
authors: R
authors: Tauchi
authors: Department of Orthopaedics and Spine Surgery, Meijo Hospital, 1-3-1, Sannomaru, Naka-ku, Nagoya, 460-0001, Japan. nupriver@gmail.com.
authors: Noriaki
authors: 0000-0002-7780-1020
authors: N
authors: Kawakami
authors: Department of Orthopaedics and Spine Surgery, Meijo Hospital, 1-3-1, Sannomaru, Naka-ku, Nagoya, 460-0001, Japan.
authors: Taichi
authors: T
authors: Tsuji
authors: Department of Orthopaedics and Spine Surgery, Meijo Hospital, 1-3-1, Sannomaru, Naka-ku, Nagoya, 460-0001, Japan.
authors: Tetsuya
authors: T
authors: Ohara
authors: Department of Orthopaedics and Spine Surgery, Meijo Hospital, 1-3-1, Sannomaru, Naka-ku, Nagoya, 460-0001, Japan.
authors: Yoshitaka
authors: Y
authors: Suzuki
authors: Department of Orthopaedics and Spine Surgery, Meijo Hospital, 1-3-1, Sannomaru, Naka-ku, Nagoya, 460-0001, Japan.
authors: Toshiki
authors: T
authors: Saito
authors: Department of Orthopaedics and Spine Surgery, Meijo Hospital, 1-3-1, Sannomaru, Naka-ku, Nagoya, 460-0001, Japan.
authors: Ayato
authors: A
authors: Nohara
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D005660:Funnel Chest / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D007738:Kyphosis / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D011184:Postoperative Period; D016684:Prone Position; D012189:Retrospective Studies; D012600:Scoliosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D013249:Sternum / Q000000981:diagnostic imaging / Q000473:pathology; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging; D013909:Thorax / Q000473:pathology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
keywords: Haller index; Pectus excavatum; Scoliosis; Sternum; Surgical treatment