Abstract
Introduction: This study highlights the occurrence of significant post operative scoliosis associated with en-bloc resection of pancoast or superior sulcus tumours. We observed the rapid onset of high thoracic scoliosis following en-bloc resections. The Magnitude of the scoliosis, and predisposing surgical factors were reviewed in each of the cases implicating the role of the transverse process or its associated structures in the stabilization of the spine.
Methods: Sixteen patients undergoing en-bloc resection for pancoast tumour were retrospectively reviewed. This was a single surgeon series where all patients had tumour resection over a 3 year period. The number of upper ribs and transverse processes resected were analysed and compared with the magnitude of scoliosis that developed over a follow up period of 2 years.
Results: Four patients had significant resection of the transverse processes of T1 to T3. All of these patients developed scoliosis of rapid onset, convex to the side of the resection. Of the remaining 12 patients either no scoliosis developed, (6 of 12), or scoliosis of less than 12 degrees.
Discussion: We observed rapid development of thoracogenic scoliosis in patients following lung tumour and chest wall resection. Our study shows that excision of the transverse processes is associated with subsequent development of an upper thoracic scoliosis. Preservation of the transverse process appears to be protective. Large resections can be performed with no subsequent scoliosis provided the transverse processes remain intact.
This suggests that the transverse process or its associated structures have an important stabilizing function on the spine.
Correspondence should be addressed to Ms Alison McGregor, c/o BOA, SBPR at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE.
