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Prognostic Risk Factors for the Development of Scoliosis After Chest Wall Resection for Malignant Tumors in Children
Aurélien Scalabre, MD1; Roger Parot, MD2; Frédéric Hameury, MD1; Vincent Cunin, MD1; Jean-Luc Jouve, PhD3; Franck Chotel, PhD1
1 Hôpital Femme Mère Enfant, Department of Pediatric Surgery, 59 Bd Pinel, 69500 Bron, France. E-mail address for A. Scalabre: aurelien.scalabre@chu-lyon.fr. E-mail address for F. Hameury: frederic.hameury@chu-lyon.fr. E-mail address for V. Cunin: vincent.cunin@chu-lyon.fr. E-mail address for F. Chotel: franck.chotel@yahoo.co.uk
2 Clinique du Val d’Ouest, Department of Pediatric Surgery, 39 Chemin de la Vernique, 69130 Ecully, France. E-mail address: rpparot@hotmail.fr
3 Hôpital de la Timone, Department of Pediatric Orthopedic Surgery, 264 Rue Saint Pierre, 13385 Marseille, France. E-mail address: jean-luc.jouve@ap-hm.fr
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Investigation performed at Hôpital Femme Mère Enfant, Department of Pediatric Surgery, Bron, France

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2014 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2014 Jan 15;96(2):e10 1-7. doi: 10.2106/JBJS.L.01535
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Surgical resection of a malignant tumor of the chest wall in children may result in the development of progressive scoliosis. The aim of this study was to identify the risk factors associated with scoliosis following resection of a tumor of the chest wall and to evaluate the prevalence and characteristics of the scoliosis.


Forty children who underwent resection of a malignant tumor of the chest wall from 1984 to 2005 were included in a multicenter, retrospective cohort study. The mean age of the patients at the time of surgery was 9.8 years (range, 0.2 to nineteen years). Resections were classified with the use of the following scheme: the number of resected ribs was noted in Roman numerals, and the level of the resection was identified by dividing the thorax into three sectors (A [anterior], B [lateral], and C [posterior]) in the horizontal plane. One to five ribs (mean, 2.3 ribs) were resected. Patients with scoliosis were compared with patients who did not have scoliosis through the use of univariate and multivariate analyses. The mean duration of follow-up was 8.5 years (range, three to twenty-three years).


Patients who had a tumor resection during a rapid-growth period (patient age of less than six years or between twelve and fifteen years) had a 5.8 times higher risk of scoliosis. The resection of three or more ribs in the posterior sector (C) was the primary risk factor for scoliosis, with an odds ratio of 18.9. Seventeen (43%) of the children developed scoliosis, which was convex toward the resection side without vertebral rotation in all of them.


The risk of scoliosis following the resection of a primary malignant tumor of the chest wall in children was shown to be higher when resection was performed during a rapid-growth period and when the resection involved three or more ribs in the posterior sector.

Level of Evidence: 

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Peer Review 

This article was reviewed by the Editor-in-Chief and one Deputy Editor, and it underwent blinded review by two or more outside experts. It was also reviewed by an expert in methodology and statistics. The Deputy Editor reviewed each revision of the article, and it underwent a final review by the Editor-in-Chief prior to publication. Final corrections and clarifications occurred during one or more exchanges between the author(s) and copyeditors.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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