Abstract
BackgroundPatients with Marfan syndrome commonly require spinal deformity surgery. The purpose of this case report is to present a rare thoracotomy complication. We present the management of such a patient.Case summaryIn a known case of Marfan syndrome, an 18-year-old Persian man was admitted to our hospital with scoliosis. The patient underwent radiological examinations, and thoracic scoliosis of 70° was diagnosed. A right thoracotomy for anterior spinal fusion from the sixth rib and posterior spinal fusion were performed successfully. Two months later, he was readmitted because of winging of the right scapula due to serratus anterior palsy. Electromyography and nerve conduction velocity confirmed long thoracic nerve injury. Conservative treatment was provided. Ultimately, the patient recovered completely in the last follow-up visit 6 months after the surgery.DiscussionThis is the first report of ipsilateral winged scapula after thoracotomy. Attention needs to be paid to surgical techniques in patients with Marfan syndrome.
Highlights
Marfan syndrome (MFS) is an illness of connective tissue, mainly involving the musculoskeletal, ocular, and cardiovascular systems [1], with an incidence of 2–3 per 10,000 population [1, 2]
Attention needs to be paid to surgical techniques in patients with Marfan syndrome
Scoliosis occurs in approximately 50–70% of patients with MFS and differs from idiopathic adolescent scoliosis with regard to curve pattern, progression, and symptoms [3]
Summary
Passive adduction of the arm may cause the scapula to shift anteriorly, for example, when a patient’s arm is raised and crossed over his or her chest This could cause creasing of the muscle and compression of the long thoracic nerve [9]. In MFS, because of joint laxity, intraoperative stretching on the ribs and scapula can cause injury to the nerve that is greater than in other patients In this study, it seems that, due to thoracotomy from the sixth rib and scapular traction during surgery, iatrogenic injury to the long thoracic nerve and winged scapula was observed. Some propose that nonoperative treatment may be the best course of action for patients with minimal symptoms [8], which is in line with this study This case was unique insofar as there is no prior report of this in a Marfan patient undergoing scoliosis repair. It informs the decision-making process, allowing other clinicians to gain a broader understanding of clinical diagnoses, treatments, and outcomes of their cases
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