Defining Thoracic Kyphosis in Patients with Pectus Excavatum

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Defining Thoracic Kyphosis in Patients with Pectus Excavatum Elizabeth A. Berdan MD, A. Noelle

Defining Thoracic Kyphosis in Patients with Pectus Excavatum Elizabeth A. Berdan MD, A. Noelle Larson MD, Daniel A. Saltzman MD Ph. D, David W. Polly Jr. , MD CHEST WALL & SPINAL DEFORMITY STUDY GROUP UNIVERSITY OF MINNESOTA ICEOS November 2011

Case Presentation Patient LH is a 12 year old girl with kyphoscoliosis and pectus

Case Presentation Patient LH is a 12 year old girl with kyphoscoliosis and pectus excavatum who presented to the Orthopaedic Clinic for correction of her severe kyphoscoliosis.

After surgical correction of her kyphoscoliosis her pectus excavatum deformity was enhanced. She

After surgical correction of her kyphoscoliosis her pectus excavatum deformity was enhanced. She was severely symptomatic with the acute decrease in her thoracic volume.

Before correction of kyphoscoliosis Increased pectus excavatum deformity With the acute decrease of space

Before correction of kyphoscoliosis Increased pectus excavatum deformity With the acute decrease of space in her mediastinum after correction of her kyphosis this 12 year old was unable to ascend a flight of stairs without severe shortness of breath. This lead to the formation of a multidisciplinary study

Chest Wall &Spine Deformity Study Group University of Minnesota Department of Orthopaedic Surgery Charles

Chest Wall &Spine Deformity Study Group University of Minnesota Department of Orthopaedic Surgery Charles Gerald T. Ledonio, MD David W. Polly, Jr. , MD Department of Pediatric Surgery Robert A. Acton, MD Donavan J. Hess, MD Daniel A. Saltzman, MD, Ph. D Department of General Surgery Elizabeth A. Berdan, MD Department of Pediatric Pulmonology Warren E. Regelmann, MD Department of Physical Medicine & Rehabilitiation David Nuckley, Ph. D Hanna Naegeli Department of Pediatric Radiology F. Glen Seidel, MD Mayo Clinic Department of Orthopaedic Surgery A. Noelle Larson, MD

Background Moderate scoliosis (greater than 30°) 1 out of 300 children Pectus malformation 1

Background Moderate scoliosis (greater than 30°) 1 out of 300 children Pectus malformation 1 out of 300 -400 children While scoliosis and pectus deformities are the most common malformations in children the interrelationship of spine and chest wall is not understood.

Our current study Hyperkyphosis may be a potential compensatory mechanism for increasing the thoracic

Our current study Hyperkyphosis may be a potential compensatory mechanism for increasing the thoracic volume in patients with pectus excavatum. Retrospective review 238 consecutive patients with pectus excavatum 79 patients with lateral chest x-rays

Measurement of Kyphosis Measure the Cobb angle from T 5 to T 12 238

Measurement of Kyphosis Measure the Cobb angle from T 5 to T 12 238 consecutive patients 79 with standing lateral chest x- rays Compared to data from patients with adolescent idiopathic scoliosis

Results Thoracic Hypokyphosis (<10°) 16/79 = 20% Normal Thoracic Kyphosis (10 -40°) 61/79 =

Results Thoracic Hypokyphosis (<10°) 16/79 = 20% Normal Thoracic Kyphosis (10 -40°) 61/79 = 77% Increased Kyphosis (>40°) 2/79 = 3%

Conclusions The thoracic kyphosis of patients with pectus excavatum is similar to that of

Conclusions The thoracic kyphosis of patients with pectus excavatum is similar to that of scoliosis patients. Pectus deformity appears to exist independent from thoracic sagittal contour abnormalities.

Future Directions Evaluating the coronal plane alignment in patients with pectus Defining the prevalence

Future Directions Evaluating the coronal plane alignment in patients with pectus Defining the prevalence of pectus deformity in children with scoliosis

This study is funded by a grant from The Chest Wall and Spinal Deformity

This study is funded by a grant from The Chest Wall and Spinal Deformity Research Foundation

Pectus Excavatum A New Perspective on Correction WhatPectus Excavatum A New Perspective on Correction What
Thoracic Outlet Syndrome TOS Thoracic Outlet Syndrome ThoracicThoracic Outlet Syndrome TOS Thoracic Outlet Syndrome Thoracic
Thoracic Spine Thoracic Cage Anterior Thoracic Cage PosteriorThoracic Spine Thoracic Cage Anterior Thoracic Cage Posterior
Preoperative Thoracic Kyphosis Can Predict Complications in GrowingPreoperative Thoracic Kyphosis Can Predict Complications in Growing
Defining Zone Assignments Concept Defining Zone Assignments DefiningDefining Zone Assignments Concept Defining Zone Assignments Defining
Unit 6 DEFINING AND NON DEFINING DEFINING RELATIVEUnit 6 DEFINING AND NON DEFINING DEFINING RELATIVE
Defining Inventory Pairs Concept Defining Inventory Pairs DefiningDefining Inventory Pairs Concept Defining Inventory Pairs Defining
Defining Allocations Concept Defining Allocations Defining Allocations StepDefining Allocations Concept Defining Allocations Defining Allocations Step
Defining Putaway Options Concept Defining Putaway Options DefiningDefining Putaway Options Concept Defining Putaway Options Defining
Defining Storage Areas Concept Defining Storage Areas DefiningDefining Storage Areas Concept Defining Storage Areas Defining
Defining Multicurrency Options Concept Defining Multicurrency Options DefiningDefining Multicurrency Options Concept Defining Multicurrency Options Defining