The patient is a 29-year-old woman who has had flatback syndrome since childhood. Over the past two years, she has developed breathing discomfort, which has worsened over time. This has led to severe coughing and expectoration every morning, and sometimes even breathing difficulty. Medical examinations revealed an enlarged ascending aorta, significant tracheal compression, and severe airway narrowing. She attempted to undergo tracheal stent placement, but the implantation of the stent could not be completed due to the severe tracheal compression. Given that the root cause of this severe compression is her flatback syndrome, she was ultimately transferred to our hospital for further treatment.

The patient’s thoracic spine is unnaturally flat with a slight forward curvature at the upper thoracic vertebrae, reducing the distance between it and the anterior chest wall. Additionally, the ascending aorta is dilated, and the trachea is noticeably compressed, particularly severely at the start of the aortic arch. The patient was ultimately diagnosed with flatback syndrome combined with severe tracheal stenosis.

1. An incision was made in the middle of the anterior chest wall to reveal the underlying bone structures.

2. The upper portion of the sternum and the first and second ribs on each sides were excised, revealing that the ascending aorta, aortic arch were closely adjacent to the heart and sternum. Additionally, significant enlargement of the thymus was observed.

3. The thymus was excised and the anterior chest wall was reconstructed using a custom digital material tailored from the patient’s chest data. This ensured a clearance of about 2cm between the chest wall and the ascending aorta.

4. The trachea was confirmed to be free of compression, with the airway pressure reduced from 23 to 12.

5. The digital material was covered with fibrous membranes.

6. Drainage tubes were indwelt and the incisions were sutured.

The surgery proceeded smoothly without any complications.

Chest Wall Reconstruction Surgery Offers New Insights for Treating Flatback Syndrome

Flatback syndrome is an extremely rare spinal deformity characterized by a flattened thoracic spine and a loss of natural spinal curvature. This significantly narrows the space between the thoracic spine and the anterior chest wall, leading to a reduced volume of the chest cavity and compression of the mediastinum. Consequently, complications such as the displacement and compression of the heart, major blood vessels, and trachea may arise. Typically, while symptoms can be managed with conservative treatments, surgical intervention is required when these methods are proven to be ineffective.

However, now there is no effective surgical method to alter the shape of spine. In this case, chest wall reconstruction surgery offers a novel approach. This surgery involves shaping and reconstructing the entire chest wall, thereby pushing the anterior chest wall forward. By expanding the front-to-back diameter of the chest wall, this surgery alleviates pressure on the heart and other mediastinal organs.

In this particular case, innovative materials were used to reconstruct the patient’s chest wall, successfully resolving the severe tracheal compression caused by flatback syndrome. The success of this surgery not only demonstrates its viability and effectiveness but also sets a precedent for future surgical treatments of flatback syndrome.