ChestWallAnomaliesandtheirTreatment.docVIP

New Therapies for Chest Wall and Spine Disorders in Children. Gregory J. Redding MD Professor of Pediatrics, University of Washington School of Medicine Chief, Pulmonary and Sleep Medicine Division, Seattle Childrens Hospital Seattle, Washington, USA Key words: scoliosis, thoracic insufficiency children Mailing Address: Pulmonary and Sleep Medicine Division, Office A-5937 Seattle Childrens Hospital 4800 Sand Point Way N.E. Seattle, Washington, USA e-mail: gredding@u.washington.edu Telephone: 206-987-2174 Fax: 206-987-2639 Traditionally chest wall or thoracic cage disorders were considered independently from spine disorders. In many cases this is appropriate, such as with pectus deformities. However, there is an increasing awareness that thoracic and pulmonary disorders can affect spine growth and configuration and that spine deformities affect thoracic cage, diaphragm, and hence respiratory growth and function. Recently, the term Thoracic Insufficiency Syndrome has been coined to describe a variety of spine and thoracic cage disorders that produce “an inability to support normal respiratory function and postnatal lung growth in children with skeletal immaturity.(1) TIS results from structural abnormalities of bones in the spine and ribs, known as primary TIS or it can occur as a result of scoliosis due to neuromuscular conditions producing weakness or spasticity (secondary TIS). A third category of TIS are thoracic deformities that occur as a result of surgical resection or congenital absence of ribs, producing a flail chest syndrome. Changes in spine configuration that contribute to poor chest wall excursion and loss of thoracic cage compliance include scoliosis, kyphosis, and lordosis of the thoracic region with or without a cervical or lumbar component. The deformities can vary by site and length along the spine and can be associated with primary rib anomalies, such as fused ribs. Congenital scoliosis includes conditions that have structural anomalies of t