Clinical significance of concomitant pectus deformity and adolescent idiopathic scoliosis: systematic review with best evidence synthesis

Laurian J M van Es, Barend J van Royen, Matthijs W N Oomen, Laurian J M van Es, Barend J van Royen, Matthijs W N Oomen

Abstract

Background: A misbalance in forces is proposed for causing adolescent idiopathic scoliosis (AIS). AIS is therefore correlated to adjacent musculoskeletal pathologies. Its concomitance with idiopathic pectus deformities (PD) is underexposed. This systematic review analyzes the clinical significance and predictive factors of PD-associated AIS.

Methods: A search was performed in PubMed, UpToDate, Embase, and Cochrane. A study was included if it: assessed the association between PD and scoliosis (category I), reported a prevalence of scoliosis in PD patients (category II), or addressed other topics about PD-associated AIS (category III). Studies in category I discussing predictive factors were appraised using the Quality in Prognosis Studies tool. Because of heterogeneity among the studies, predictive factors were analyzed according to a best evidence synthesis. A mean prevalence of scoliosis in PD patients was calculated using category I and II. Category III was narratively reviewed.

Results: Forty-eight studies were included (I:19, II:21, III:8). Category I comprised 512 patients with PD-concomitant scoliosis. Thirteen studies reported predictive factors, of which 15 concerned the prevalence of scoliosis in PD patients and 12 Cobb Angle (CA) change after PD correction. Compared with AIS, PD seems to develop earlier in adolescence, and PD with concomitant AIS was more frequently reported in older patients. Evidence remained conflicting regarding the association between the severity of PD and that of scoliosis. As opposed to at a younger age, late PD correction is not associated with a postoperative increase of CA. Limited evidence showed that patients with a high CA undergoing PD correction do not experience an increase in CA, though, strong evidence indicated that it would not lead to a decrease in CA. The mean probable prevalence of AIS in PD patients was 13.1%.

Conclusion: Current literature confirms the association between PD and AIS in patients with an indication for PD correction.Level of evidence: III.

Keywords: AIS, Adolescent Idiopathic Scoliosis; Adolescent idiopathic scoliosis (AIS); BES, Best Evidence Synthesis; BMI, Body Mass Index; CA, Cobb Angle; CT, Computed Tomography; Chest wall deformities; Funnel chest; HI, Haller Index; PC, Pectus Carinatum; PD, Pectus Deformity; PE, Pectus Excavatum; Pectus carinatum; Pectus excavatum; Pigeon breast; STA, Sternal Tilt Angle; Scoliosis.

Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

© 2022 The Author(s). Published by Elsevier Ltd on behalf of North American Spine Society.

Figures

Figure 1
Figure 1
PRISMA 2020 flow diagram of identification, screening, and inclusion of papers in the 3 categories.

References

    1. Shakil H., Iqbal Z.A., Al-Ghadir A.H. Scoliosis: review of types of curves, etiological theories and conservative treatment. J Back Musculoskelet Rehabil. 2014;27(2):111–115.
    1. Smit T.H. Adolescent idiopathic scoliosis: The mechanobiology of differential growth. JOR Spine. 2020;3(4):e1115.
    1. Uçar İ., et al. Is scoliosis related to mastication muscle asymmetry and temporomandibular disorders? A cross-sectional study. Musculoskelet Sci Pract. 2022;58:1025–1033.
    1. Bortz C., et al. The Prevalence of Hip Pathologies in Adolescent Idiopathic Scoliosis. J Orthop. 2022;31:29–32.
    1. Waters P., et al. Scoliosis in children with pectus excavatum and pectus carinatum. J Pediatr Orthop. 1989;9(5):551–556.
    1. Al-Qadi M.O. Disorders of the Chest Wall: Clinical Manifestations. Clin Chest Med. 2018;39(2):361–375.
    1. Haller J.A., Jr., Kramer S.S., Lietman S.A. Use of CT scans in selection of patients for pectus excavatum surgery: a preliminary report. J Pediatr Surg. 1987;22(10):904–906.
    1. Swoveland B., et al. The Nuss procedure for pectus excavatum correction. Aorn j. 2001;74(6):828–841. quiz 842-5, 848-50.
    1. Niedbala A., et al. Acquired thoracic scoliosis following minimally invasive repair of pectus excavatum. Am Surg. 2003;69(6):530–533.
    1. Beltsios E.T., Mitsos S.L., Panagiotopoulos N.T. Pectus excavatum and scoliosis: a review about the patient's surgical management. Gen Thorac Cardiovasc Surg. 2020;68(11):1225–1233.
    1. Page M.J., et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. International Journal of Surgery. 2021;88
    1. Hayden J.A., et al. Assessing bias in studies of prognostic factors. Ann Intern Med. 2013;158(4):280–286.
    1. Faraj S.S., et al. De novo degenerative lumbar scoliosis: a systematic review of prognostic factors for curve progression. Eur Spine J. 2016;25(8):2347–2358.
    1. van den Bogaart M., et al. Predictive factors for brace treatment outcome in adolescent idiopathic scoliosis: a best-evidence synthesis. Eur Spine J. 2019;28(3):511–525.
    1. Slavin R.E. Best evidence synthesis: an intelligent alternative to meta-analysis. J Clin Epidemiol. 1995;48(1):9–18.
    1. Alaca N., Yüksel M. Comparison of physical functions and psychosocial conditions between adolescents with pectus excavatum, pectus carinatum and healthy controls. Pediatr Surg Int. 2021;37(6):765–775.
    1. Berdan E., et al. Double Crush to the Thorax: Pectus Excavatum and Kyphoscoliosis. Journal of Pediatric Surgery Case Reports. 2013;2
    1. Choi J.H., et al. Classification of Pectus Excavatum According to Objective Parameters From Chest Computed Tomography. Ann Thorac Surg. 2016;102(6):1886–1891.
    1. Chung J.H., Park H.J., Kim K.T. Scoliosis after pectus excavatum correction: does it improve or worsen? Eur J Cardiothorac Surg. 2017;52(1):76–82.
    1. Floccari L.V., Sucato D.J., Ramo B.A. Scoliosis Progression After the Nuss Procedure for Pectus Excavatum: A Case Report. Spine Deform. 2019;7(6):1003–1009.
    1. Ghionzoli M., et al. Scoliosis and Pectus Excavatum in Adolescents: Does the Nuss Procedure Affect the Scoliotic Curvature? J Laparoendosc Adv Surg Tech A. 2016;26(9):734–739.
    1. Hong J.Y., et al. Correlations of adolescent idiopathic scoliosis and pectus excavatum. J Pediatr Orthop. 2011;31(8):870–874.
    1. İşcan M., et al. The effect of minimally invasive pectus excavatum repair on thoracic scoliosis. Eur J Cardiothorac Surg. 2020
    1. Meng Y., et al. Acquired scoliosis following Nuss procedure for pectus excavatum: A case report. Medicine (Baltimore) 2019;98(1):e13855.
    1. Nagasao T., et al. Dynamic effects of the Nuss procedure on the spine in asymmetric pectus excavatum. J Thorac Cardiovasc Surg. 2010;140(6) p. 1294-9 e1.
    1. Park H.J., et al. Effects of Nuss procedure on thoracic scoliosis in patients with pectus excavatum. J Thorac Dis. 2017;9(10):3810–3816.
    1. Shu Q., et al. Experience in minimally invasive Nuss operation for 406 children with pectus excavatum. World J Pediatr. 2011;7(3):257–261.
    1. Tauchi R., et al. Evaluation of thoracic factors after scoliosis surgery in patients with both scoliosis and pectus excavatum. Eur Spine J. 2018;27(2):381–387.
    1. Tauchi R., et al. Clinical Characteristics and Thoracic factors in patients with Idiopathic and Syndromic Scoliosis Associated with Pectus Excavatum. Spine Surg Relat Res. 2018;2(1):37–41.
    1. Tomaszewski R., Wiktor L., Machala L. Evaluation of thoracic vertebrae rotation in patients with pectus excavatum. Acta Orthop Traumatol Turc. 2017;51(4):284–289.
    1. Wang Y., et al. Mechanical factors play an important role in pectus excavatum with thoracic scoliosis. J Cardiothorac Surg. 2012;7:118.
    1. Zhong W., et al. Effects of Pectus Excavatum on the Spine of Pectus Excavatum Patients with Scoliosis. J Healthc Eng. 2017;2017
    1. Akcali Y., Ceyran H., Hasdiraz L. Chest wall deformities. Acta Chir Hung. 1999;38(1):1–3.
    1. Coln D., et al. Early experience with the Nuss minimally invasive correction of pectus excavatum in adults. World J Surg. 2002;26(10):1217–1221.
    1. Fonkalsrud E.W. Surgical correction of pectus carinatum: lessons learned from 260 patients. J Pediatr Surg. 2008;43(7):1235–1243.
    1. Fonkalsrud E.W. 912 open pectus excavatum repairs: changing trends, lessons learned: one surgeon's experience. World J Surg. 2009;33(2):180–190.
    1. Haje S.A., de Podesta Haje D. Orthopedic Approach to Pectus Deformities: 32 Years of Studies. Rev Bras Ortop. 2009;44(3):191–198.
    1. Kelly R.E., et al. Twenty-one years of experience with minimally invasive repair of pectus excavatum by the Nuss procedure in 1215 patients. Ann Surg. 2010;252(6):1072–1081.
    1. Kelly R.E., Jr., et al. Recent Modifications of the Nuss Procedure: The Pursuit of Safety During the Minimally Invasive Repair of Pectus Excavatum. Ann Surg. 2020
    1. Kelly R.E., Jr., et al. Prospective multicenter study of surgical correction of pectus excavatum: design, perioperative complications, pain, and baseline pulmonary function facilitated by internet-based data collection. J Am Coll Surg. 2007;205(2):205–216.
    1. Koumbourlis A.C., Stolar C.J. Lung growth and function in children and adolescents with idiopathic pectus excavatum. Pediatr Pulmonol. 2004;38(4):339–343.
    1. Kuru P., et al. Quality of life improves after minimally invasive repair of pectus excavatum. Asian Cardiovasc Thorac Ann. 2015;23(3):302–307.
    1. Kuru P., et al. Pectus Excavatum and Pectus Carinatum: Associated Conditions, Family History, and Postoperative Patient Satisfaction. Korean J Thorac Cardiovasc Surg. 2016;49(1):29–34.
    1. Lopez M., et al. Preliminary study of efficacy of dynamic compression system in the correction of typical pectus carinatum. Eur J Cardiothorac Surg. 2013;44(5):e316–e319.
    1. Luu T.D., et al. Surgery for recurrent pectus deformities. Ann Thorac Surg. 2009;88(5):1627–1631.
    1. Mandhan P., et al. Pectus Deformities in Children: A nine-year experience from CMH, USA. Asian J Surg. 1999;22:301–307.
    1. McHugh M.A., et al. Assessment of potential confounders when imaging pectus excavatum with chest radiography alone. J Pediatr Surg. 2016;51(9):1485–1489.
    1. Murphy B.L., et al. Minimal cosmetic revision required after minimally invasive pectus repair. Pediatr Surg Int. 2018;34(7):775–780.
    1. Okuyama H., et al. Thoracoscopic Costal Cartilage Excision Combined with the Nuss Procedure for Patients with Asymmetrical Pectus Excavatum. J Laparoendosc Adv Surg Tech A. 2021;31(1):95–99.
    1. Prats M.R., et al. Corrección mínimamente invasiva (Operación de Nuss) del pectus excavatum en pacientes adultos. Revista médica de Chile. 2009;137:1583–1590.
    1. Ramadan S., et al. Cardiopulmonary function in adolescent patients with pectus excavatum or carinatum. BMJ Open Respir Res. 2021;8(1)
    1. Schoenmakers M.A., et al. Physiotherapy as an adjuvant to the surgical treatment of anterior chest wall deformities: a necessity? A prospective descriptive study in 21 patients. J Pediatr Surg. 2000;35(10):1440–1443.
    1. Westphal F.L., et al. Prevalence of pectus carinatum and pectus excavatum in students in the city of Manaus, Brazil. J Bras Pneumol. 2009;35(3):221–226.
    1. Creswick H.A., et al. Family study of the inheritance of pectus excavatum. J Pediatr Surg. 2006;41(10):1699–1703.
    1. de Beer S.A., et al. The Dynamic Compression Brace for Pectus Carinatum: Intermediate Results in 286 Patients. Ann Thorac Surg. 2017;103(6):1742–1749.
    1. Gurnett C.A., et al. Genetic linkage localizes an adolescent idiopathic scoliosis and pectus excavatum gene to chromosome 18 q. Spine (Phila Pa 1976) 2009;34(2):E94–100.
    1. Karner C.M., et al. Gpr126/Adgrg6 deletion in cartilage models idiopathic scoliosis and pectus excavatum in mice. Hum Mol Genet. 2015;24(15):4365–4373.
    1. Neves S.C., et al. Finite element analysis of pectus carinatum surgical correction via a minimally invasive approach. Computer Methods in Biomechanics and Biomedical Engineering. 2015;18(7):711–720.
    1. Ye J.D., H Y.-W., Zhong W-H, Liu J-F, Zhang C-Q. Investigation on the electrometric measurement experiment of the artificial thoracic model of pectus excavatum with scoliosis. Biomedical Research. 2017;28(9):3845–3850.
    1. Ye J.D., et al. Effect on Chest Deformation of Simultaneous Correction of Pectus Excavatum with Scoliosis. J Healthc Eng. 2017;2017
    1. Ye J.-D., et al. The analysis of the effect of intervertebral disc on the lateral bending of the spine in deformed thorax model. Biomedical Research (India) 2017;28(7):3271–3275.
    1. Ye, J.-D., et al., Investigation on the electrometric measurement experiment of the artificial thoracic model of pectus excavatum with scoliosis. 2017.
    1. Sanders J.O., et al. Maturity assessment and curve progression in girls with idiopathic scoliosis. J Bone Joint Surg Am. 2007;89(1):64–73.
    1. Konieczny M.R., Senyurt H., Krauspe R. Epidemiology of adolescent idiopathic scoliosis. J Child Orthop. 2013;7(1):3–9.
    1. Alexianu D., et al. Severe hypotension in the prone position in a child with neurofibromatosis, scoliosis and pectus excavatum presenting for posterior spinal fusion. Anesth Analg. 2004;98(2):334–335.
    1. Bafus B.T., et al. Severe hypotension associated with the prone position in a child with scoliosis and pectus excavatum undergoing posterior spinal fusion. J Spinal Disord Tech. 2008;21(6):451–454.
    1. Galas J.M., et al. Echocardiographic diagnosis of right ventricular inflow compression associated with pectus excavatum during spinal fusion in prone position. Congenit Heart Dis. 2009;4(3):193–195.
    1. Akkaş Y., et al. The prevalence of chest wall deformity in Turkish children. Turk J Med Sci. 2018;48(6):1200–1206.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi