Surgical Treatment of Scoliosis Developed After Extended Chest Wall Resection Due to Askin Tumor During Childhood.

STUDY DESIGN

Report of four cases.

OBJECTIVE

To describe a series of pediatric patients with surgical scoliosis after chest wall resections due to Askin tumors.

SUMMARY OF BACKGROUND DATA

Askin tumors are a rare type of chest wall solid tumors that can develop in children. Treatment involves chemotherapy and extensive surgical resection, including disarticulation of several ribs. This can cause thoracogenic scoliosis, with very scarce data found in the literature regarding its treatment and prognosis.

MATERIALS AND METHODS

Retrospective descriptive series of four cases of scoliosis in pediatric patients, secondary to extensive chest resections due to Akin's tumors. We analyzed the results of the surgical treatment.

RESULTS

Three girls and one boy with a mean age of 8.7 ± 2.2 years and 7 ± 3.6 years of follow-up were included. In all cases, the convexity of the thoracic curvature was toward the area of chest resection, occurring a mean of 1.9±1.3 years after thoracic surgery. A distraction-based system (two vertically expandable prosthetic titanium rib [VEPTR], two traditional growing rods) was used to correct the scoliosis. The preoperative Cobb angle (68.7° ± 22.9°) was corrected to 32.6° ± 9.7° at final follow-up. Preoperative coronal imbalance was 2.95 ± 1.86 cm and was corrected to 0.3 ± 0.6 cm at final follow-up. No changes were observed regarding preoperative kyphosis 30° ± 8.7° (33°±8° final). T1-S1 initial length was 29.65 cm changing to 40.65 cm. T1-T12 height went from 18.25 to 23.67 cm. There was one complication secondary to the proximal anchoring.

CONCLUSIONS

For treatment of scoliosis secondary to extensive chest resection in the growing children with Askin tumors, distraction-based growth-friendly treatment is an available surgical option. Seven years of follow-up showed more than 50% improvement of the Cobb angle, and an average thoracic and trunk growth of 5.42 and 11 cm, respectively.

LEVEL OF EVIDENCE

Level IV.