Living with TIS can be a challenging, complex journey. Both children and adults with TIS need expert support and ongoing care from qualified medical professionals to live their best, most comfortable lives. Our guide provides clarity on causes, symptoms and treatments.
TIS occurs when musculoskeletal abnormalities around the chest or “thorax” limit the lungs’ ability to grow during childhood and function properly later in life, hindering normal respiration and breathing.
The alveoli — the air sacs that exchange oxygen for carbon dioxide in the lungs — develop primarily during a child’s first five years of life. With limited space to grow, fewer alveoli can form. If rib cage size is restricted, the lungs also can’t expand enough, causing discomfort and other symptoms.
If you’re living with thoracic insufficiency, you may experience one or more of these symptoms because of your reduced chest cavity size:
There are several causes for TIS. Some are genetic, some are environmental and some are multifactorial, meaning the syndrome is caused by a combination of factors. If you have TIS, you likely have a condition that falls into one of the following four categories:
When the spine twists or bends more significantly than usual, it can limit space in the chest cavity or “thoracic cage” and cause ribs to grow compressed or misaligned, hindering breathing. Spinal conditions that can cause TIS include:
Abnormal rib development can restrict lung growth and impede the rib cage from expanding properly during breathing. Malformations that can cause TIS are:
Neuromuscular conditions can lead to muscle weakness, spasticity and spinal deformities, which contribute to TIS by restricting respiratory capacity and space within the thorax. Conditions include:
Several other disorders also contribute to thoracic insufficiency through structural or developmental issues:
To diagnose TIS, doctors will review your medical history, assess your symptoms and conduct a thorough physical examination to evaluate your posture. Medical practitioners will also use imaging studies like X-rays to assess spinal curvature and rib structure. Computed tomography (CT) scans also give doctors detailed information about the structure of your thoracic cavity.
Next, you’ll do pulmonary function tests (PFTs) to measure how well you breathe in different circumstances, including during exercise. If doctors suspect a genetic condition, you may undergo genetic testing. Depending on your results, you’ll be referred to specialists such as spine surgeons, orthopedic surgeons or pulmonologist.
The best TIS treatment depends on the specific cause, the patient’s age and needs and the symptoms’ severity. Usually, a combination of treatments or a multidisciplinary approach has the best outcomes. Regular follow-ups help prevent the condition from worsening and manage secondary symptoms. Treatments for TIS include:
Most physical therapy for TIS focuses on strengthening core muscles, enhancing flexibility and improving overall mobility. Specific exercises may target respiratory muscles to strengthen lung function. Physical therapists also teach patients breathing techniques to help maximize their lung capacity and manage any TIS-related discomfort.
Young people with minor to moderate spinal curvature conditions, like scoliosis restricting thoracic expansion, can benefit significantly from orthotic braces. These custom-fitted, wearable braces gradually guide the spine into a more upright position as the child or adolescent grows, helping prevent further curvature and opening up the chest over time to make room for lung growth and proper respiration. Types of back braces used to treat spinal curves that cause TIS include Boston braces and Rigo-Chêneau braces.
Orthotic braces are generally only effective in young people who have growing skeletons and a scoliosis curvature between 25 and 40 degrees. The best type of brace for your needs will depend on numerous factors that doctors will assess and monitor as treatment continues. Surgery is typically advised for scoliosis patients who:
Surgery for TIS has three main goals — increasing the thorax’s volume to facilitate better lung growth in young people, adjusting skeletal structure to make breathing easier and helping breathing muscles like the diaphragm engage better via spine and rib cage adjustment. Procedures are divided into two types — growth-sparing, which helps young people continue to grow taller after surgery, and non-growth-sparing, which often limits growth.
Growth-sparing TIS surgeries include:
Non-growth-sparing TIS surgeries include:
In these procedures, medical practitioners use smaller incisions than in traditional open surgery, reducing recovery time, scarring, pain and bodily trauma. These procedures require specialized instruments and imaging technology. Minimally invasive TIS procedures include:
If you’re having significant trouble breathing, you may receive respiratory support, such as supplemental oxygen or noninvasive ventilation assistance. You may also be prescribed pain-relieving or muscle-relaxant medications to help you manage symptoms and complications associated with TIS, such as chest pains or chronic back muscle spasms. Families affected by genetic syndromes, like muscular dystrophy or Jarcho-Levin syndrome, can also get genetic counseling for future pregnancies and management options.
New York Spine Institute has become the state’s largest, most comprehensive multi-specialty spine and orthopedic institute. Our industry-leading doctors and surgeons specialize in spine treatment, neurosurgery, orthopedics, pain management, physical therapy and sports medicine. NYSI is highly equipped to address the various facets of TIS, from diagnosis to treatment.
If you’re concerned about TIS or want a reliable second opinion before committing to treatment, we can help you find answers and start your journey to recovery. Our centers treat patients in New York City and surrounding areas. It’s our mission to relieve your pain and improve your quality of life using cutting-edge surgical and nonsurgical technologies.
To learn more about our expert offerings or schedule an appointment, contact us today.
