Abstract:Abstract:Introduction: The purpose of this study is to demonstrate the clinical characteristics and thoracic factors such as sternal tilt angle and Haller index in patients with idiopathic or syndromic scoliosis associated with pectus excavatum.Methods: We performed a retrospective review on a cohort of 70 patients (37 males and 33 females) diagnosed with idiopathic and syndromic scoliosis associated with pectus excavatum between 1985 and 2014. We investigated age, location and Cobb angle of the main curve, an… Show more
“…One study was identified by backward citation. Eventually, 48 studies were included: 19 in category I [ 5 , 9 , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] ], 21 in category II [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , and 8 in category III [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] ( Figure 1 ). Figure 1 PRISMA 2020 flow diagram of identification, screening, and inclusion of papers in the 3 categories.…”
Section: Resultsmentioning
confidence: 99%
“…Nineteen studies focused on the association between PD and scoliosis, of which 4 described cases [ 9 , 20 , 24 , 27 ], 5 described spinal change after PD correction [ 19 , 21 , 23 , 25 , 26 ], and 2 PD change after scoliosis correction [ 17 , 28 ]. Thirteen studies analyzed predictive factors [ 5 , 16 , 18 , 19 , [21] , [22] , [23] , 25 , 26 , [29] , [30] , [31] , [32] ], of which three solely included patients with PD-associated scoliosis [ 25 , 29 , 32 ] (Appendix B). Five of these 13 studies did not describe inclusion criteria regarding either scoliosis or syndromic cases [ 16 , 18 , 23 , 25 , 32 ].…”
Section: Resultsmentioning
confidence: 99%
“…Of the 13 studies assessed, 4 studies considered high-quality [ 16 , 19 , 26 , 29 ]. Nearly all methodological shortcomings concerned the lack of follow-up (item D), information about the loss to follow-up (items F and G), and blinding (items H and J) ( Table 1 b).…”
Section: Resultsmentioning
confidence: 99%
“…All studies reported a significantly higher prevalence of scoliosis in PD patients as compared to the general population. Most PD-associated AIS involved single curves of the middle to lower thoracic spine (Lenke type 1) [ 5 , 22 , [29] , [30] , [31] ]. Regarding convexity (right- versus left-sided scoliotic curve), the literature was contradictory [ 21 , 31 ].…”
“…One study was identified by backward citation. Eventually, 48 studies were included: 19 in category I [ 5 , 9 , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] ], 21 in category II [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , and 8 in category III [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] ( Figure 1 ). Figure 1 PRISMA 2020 flow diagram of identification, screening, and inclusion of papers in the 3 categories.…”
Section: Resultsmentioning
confidence: 99%
“…Nineteen studies focused on the association between PD and scoliosis, of which 4 described cases [ 9 , 20 , 24 , 27 ], 5 described spinal change after PD correction [ 19 , 21 , 23 , 25 , 26 ], and 2 PD change after scoliosis correction [ 17 , 28 ]. Thirteen studies analyzed predictive factors [ 5 , 16 , 18 , 19 , [21] , [22] , [23] , 25 , 26 , [29] , [30] , [31] , [32] ], of which three solely included patients with PD-associated scoliosis [ 25 , 29 , 32 ] (Appendix B). Five of these 13 studies did not describe inclusion criteria regarding either scoliosis or syndromic cases [ 16 , 18 , 23 , 25 , 32 ].…”
Section: Resultsmentioning
confidence: 99%
“…Of the 13 studies assessed, 4 studies considered high-quality [ 16 , 19 , 26 , 29 ]. Nearly all methodological shortcomings concerned the lack of follow-up (item D), information about the loss to follow-up (items F and G), and blinding (items H and J) ( Table 1 b).…”
Section: Resultsmentioning
confidence: 99%
“…All studies reported a significantly higher prevalence of scoliosis in PD patients as compared to the general population. Most PD-associated AIS involved single curves of the middle to lower thoracic spine (Lenke type 1) [ 5 , 22 , [29] , [30] , [31] ]. Regarding convexity (right- versus left-sided scoliotic curve), the literature was contradictory [ 21 , 31 ].…”
“…Furthermore, moving the right-convex thoracic spine to the left front with spinal fusion may exacerbate the posterior cardiac compression due to the corrected spine and cause deterioration of hemodynamics. 6 We report a case of a patient with Marfan syndrome with pectus excavatum and scoliosis who had hypotension and tachycardia during surgery due to the prone position assumed and correction of the thoracic spine.…”
Hemodynamics may deteriorate during the perioperative period when performing posterior spinal fusion in patients with pectus excavatum and scoliosis. A 13-year-old teenager diagnosed with Marfan syndrome had thoracic scoliosis and pectus excavatum. Thoracic scoliosis was convex to the right, and a right ventricular inflow tract stenosis was observed due to compression induced by the depressed sternum. The patient underwent T3–L4 posterior spinal fusion surgery for scoliosis. Deterioration of hemodynamics was observed when the patient was placed in the prone position or when the thoracic spine was corrected to the left front. Postoperative computed tomography examination showed that the mediastinal space was narrowed due to the corrected thoracic spine. Special attention should be paid in the following cases: (1) severe pectus excavatum, (2) right ventricular inflow tract compression due to depressed sternum on the left side, (3) correction of the thoracic spine on the left front, (4) long-term surgery, and (5) risk of massive bleeding. In some cases, pectus excavatum surgery should be prioritized.
Optimal patient positioning for spine surgery is vital for surgical success and the minimisation of complications intra-/post-operatively. In patients with complex co-morbidities, commercially available surgical positioning equipment is inadequate. To overcome this, a novel method was developed to create custom-fit patient-specific theatre mattresses for patients undergoing spine surgery. An innovative digital workflow involving 3D surface scanning, 3D simulation and computer aided design was developed to manufacture customised theatre supports with patient-specific requirements. These supports offered the surgeon an enhanced ability to relieve load bearing on prominent anatomical features or where desired, to tailor the support surface to the patient's anatomy for lengthy surgery. The bespoke theatre mattress was evaluated by whether the support resulted in a complication-free surgery. Using this new workflow, case examples for two patients with complex co-morbidities were described. The spine surgeon and anaesthetist reported the patient-specific custom mattresses were fit as per the required design, provided sufficient clearance around anatomical prominences and areas that required to be unloaded, had sufficient clearance for the anaesthetic method and cannulation, provided excellent surgical access and stability during surgery, and postoperatively no soft tissue overload over bony prominence and implanted devices. Positive patient outcomes after successful lengthy surgical interventions were associated with these patient-specific, contoured mattress supports. Future projects will seek to utilise this technology for other types of surgeries and intra-operative positioning requirements, and for a broader demographic of patients in both the paediatric and adult setting.
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