Background: Straight back syndrome and other causes of extreme narrowing of the space between sternal notch and vertebrae can cause critical tracheal obstruction. Additional points of compression may result from the brachiocephalic artery and from anterior vertebral displacement.
Methods: Individualized surgical maneuvers are necessary to correct all points of obstruction. Techniques include sternoplasty, sternal division, reimplantation of brachiocephalic artery, correction of severe pectus excavatum, and posterior wall tracheoplasty.
Results: Four patients were successfully treated by individualized techniques with complete long-term relief of critical tracheal obstruction.
Conclusions: Severe tracheal compression caused by straight back syndrome and other causes of narrowed sternospinal channel is surgically correctable.