Scoliosis Following Chest Wall Resection for Tumor With and Without Prophylactic Fixation: Case Series

Abstract

Posterior chest wall resection is a complex surgical procedure that involves removing any anatomical structure that surrounds the lungs and pleura, such as the intercostals, ribs, and soft tissues. The etiology of scoliosis that develops after chest wall excision is likely both mechanical and paralytic in nature. We report seven cases of scoliosis following posterior chest wall resection. Our results suggest that the prophylactic treatment of scoliosis after chest wall resection decreases the risk of scoliosis.

Chest Wall Reconstruction With 3D Printing: Anatomical and Functional Considerations

“…8,9,11,12 Resection of the ribs, especially the head and neck posteriorly more so than the body anteriorly without reconstruction, results in collapse of the chest wall, scoliosis, and decreased chest wall compliance. [18][19][20][21] The first rib is short, broad, and flat with a small radius of curvature (Fig. 2b).…”

“…21,35,36 Loss of skeletal support following excision of ribs results in collapse of the chest wall and scoliosis with up to 99% of patients who undergo chest wall excision demonstrating some degree of scoliosis. [18][19][20][21][22][37][38][39] Scoliosis with the concave side toward the resected ribs develops to a greater degree following resection of the head and neck of the ribs posteriorly rather than the anterior body of the ribs. 20 The degree of curvature that develops directly correlates with the number of ribs resected.…”

“…20,[37][38][39] All prevent normal inflation of the lung and compromise the physiologic and mechanical function of the thorax. [18][19][20][21][22]35,36 Therefore, a robust skeletal reconstruction with soft-tissue cover is essential to maintain the required shape and structural stability of the chest wall and maintain the core stability of the thoracic spine. By accurately mimicking the skeletal shape and structure of the chest wall being replaced, the emerging 3D printing technology allows restoration of structural shape, stability, and appearance of the chest wall and maintains its physiologic function.…”

“…The vertebral column supports the trunk, is part of the skeletal framework of the chest wall, gives structure to the chest wall dorsally, offers a stable vertical axis for the region, and plays an important role in providing core stability to the trunk and the body as a whole. 18,21,22 It provides protection to the internal organs of the thorax from injury and serves as a point of attachment to the 12 thoracic ribs and muscles in the region, which are essential for normal kinesiology of the thorax. 9,11,12,22…”

Shoulder Dysfunction After Lung Cancer Resection

“…Patients can develop scoliosis or other postural abnormalities postoperatively, which often result in completion of strengthening exercises in a suboptimal position. 9 Verbal and tactile cues to lengthen trunk musculature before completing each exercise can be helpful. Mirror training is another helpful tool due to the consistent visual feedback, particularly when performing scapular strengthening exercises.…”