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Purpose <p>One factor that may lead to the development of early-onset scoliosis (EOS) is chest wall procedures during infancy, which are common for patients with Trisomy 21 requiring cardiothoracic intervention involving thoracotomies. Studies examining scoliosis incidence in patients with prior thoracotomy demonstrate a wide incidence range. Our study aimed to assess if scoliosis prevalence is higher in patients with Trisomy 21 who underwent prior thoracotomy compared to patients who underwent sternotomy for congenital heart disease repair.</p> Methods <p>An IRB-approved, single-center retrospective review included patients aged 9&#xa0;years or older with Trisomy 21 who underwent prior cardiothoracic surgery. Exclusion criteria included other trisomy diagnoses, no cardiothoracic surgical history, unavailable operative records, and ages 0–8&#xa0;years. Medical chart review examined demographics, surgical details, and scoliosis diagnosis and management. Statistical analyses included chi-square, z test, one-way ANOVA, and descriptive statistics.</p> Results <p>Of 301 total patients, 12.6% were eventually diagnosed with scoliosis (n = 38). Common cardiothoracic procedures included atrioventricular canal repair (n = 141/301, 46.8%) and ventricular septal defect repair (n = 67/301, 22.3%). Thoracotomies were required in 7.0% (n = 21/301) at a median age of 1&#xa0;month (IQR:0–15), most commonly for patent ductus arteriosus ligation (n = 8/21, 38.0%). Among thoracotomy patients, 28.6% developed scoliosis (n = 6/21), compared to 11.4% of sternotomy patients (n = 32/280) (p = 0.023). Among all patients with scoliosis (n = 38), 36.8% required intervention in the form of non-operative (i.e. bracing) or surgical treatment due to curve presentation and/or progression (n = 14); and 13.2% ultimately required spinal fusion (n = 5).</p> Conclusion <p>Our study demonstrates that trisomy 21 patients requiring early CT intervention have greater scoliosis prevalence following thoracotomy than sternotomy. While the prevalence is greater in the thoracotomy group, the evidence suggests both cohorts must closely be monitored for spinal deformity development to intervene early and prevent progression to an operative magnitude scoliosis.</p>

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Cardiothoracic surgical incision type and later scoliosis development in trisomy 21 patients following infant cardiothoracic surgical procedures

  • 期刊论文

  • 发表日期：

    2025年12月12日

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  • Leta Ashebo,
  • Constantine D. Mavroudis,
  • Angie Kuang,
  • Patrick J. Cahill,
  • Jason B. Anari

摘要

Purpose

One factor that may lead to the development of early-onset scoliosis (EOS) is chest wall procedures during infancy, which are common for patients with Trisomy 21 requiring cardiothoracic intervention involving thoracotomies. Studies examining scoliosis incidence in patients with prior thoracotomy demonstrate a wide incidence range. Our study aimed to assess if scoliosis prevalence is higher in patients with Trisomy 21 who underwent prior thoracotomy compared to patients who underwent sternotomy for congenital heart disease repair.

Methods

An IRB-approved, single-center retrospective review included patients aged 9 years or older with Trisomy 21 who underwent prior cardiothoracic surgery. Exclusion criteria included other trisomy diagnoses, no cardiothoracic surgical history, unavailable operative records, and ages 0–8 years. Medical chart review examined demographics, surgical details, and scoliosis diagnosis and management. Statistical analyses included chi-square, z test, one-way ANOVA, and descriptive statistics.

Results

Of 301 total patients, 12.6% were eventually diagnosed with scoliosis (n = 38). Common cardiothoracic procedures included atrioventricular canal repair (n = 141/301, 46.8%) and ventricular septal defect repair (n = 67/301, 22.3%). Thoracotomies were required in 7.0% (n = 21/301) at a median age of 1 month (IQR:0–15), most commonly for patent ductus arteriosus ligation (n = 8/21, 38.0%). Among thoracotomy patients, 28.6% developed scoliosis (n = 6/21), compared to 11.4% of sternotomy patients (n = 32/280) (p = 0.023). Among all patients with scoliosis (n = 38), 36.8% required intervention in the form of non-operative (i.e. bracing) or surgical treatment due to curve presentation and/or progression (n = 14); and 13.2% ultimately required spinal fusion (n = 5).

Conclusion

Our study demonstrates that trisomy 21 patients requiring early CT intervention have greater scoliosis prevalence following thoracotomy than sternotomy. While the prevalence is greater in the thoracotomy group, the evidence suggests both cohorts must closely be monitored for spinal deformity development to intervene early and prevent progression to an operative magnitude scoliosis.