Clinical Characteristics and Thoracic factors in patients with Idiopathic and Syndromic Scoliosis Associated with Pectus Excavatum

Ryoji Tauchi, Yoshitaka Suzuki, Taichi Tsuji, Tetsuya Ohara, Toshiki Saito, Ayato Nohara, Kazuaki Morishita, Ippei Yamauchi, Noriaki Kawakami, Ryoji Tauchi, Yoshitaka Suzuki, Taichi Tsuji, Tetsuya Ohara, Toshiki Saito, Ayato Nohara, Kazuaki Morishita, Ippei Yamauchi, Noriaki Kawakami

Abstract

Introduction: The purpose of this study is to demonstrate the clinical characteristics and thoracic factors such as sternal tilt angle and Haller index in patients with idiopathic or syndromic scoliosis associated with pectus excavatum.

Methods: We performed a retrospective review on a cohort of 70 patients (37 males and 33 females) diagnosed with idiopathic and syndromic scoliosis associated with pectus excavatum between 1985 and 2014. We investigated age, location and Cobb angle of the main curve, and thoracic factors including sternal deviation and tilting angle and Haller index using radiographs and computed tomography of the chest.

Results: Patients' mean age at the first visit to our hospital was 10.3 years (1-18 years old). There were 41 patients with idiopathic scoliosis and 29 with syndromic scoliosis. Main curve locations were thoracic in 52 patients, thoracolumbar in 10, and lumbar in 8. The mean Cobb angle of the main curve was 45.0 degrees (11-109 degrees). The sternum was displaced on the left side in 72% of patients, central in 23%, and right in 5%. Mean sternal tilt angle was 12.4 degrees (2.3-34 degrees), and mean Haller index score was 4.9 (2.9-9.2). There was no significant correlation between Cobb angle and sternal tilt angle/Haller index. However, a significant difference was found between sternal tilt angle and Haller index.

Conclusion: Most patients with both scoliosis and pectus excavatum have left side deviated sternum and a higher Haller index score; therefore this can negatively impact cardiac function. Prone positioning and the corrective force applied during scoliosis surgery as well as thoracic compression during cast or brace treatment may have a negative effect on cardiac function in these patients.

Keywords: Haller index; pectus excavatum; scoliosis; sternum.

Conflict of interest statement

Conflicts of Interest: The authors declare that there are no conflicts of interest.

Figures

Figure 1.
Figure 1.
Sternal tilt angle. Axial CT scan showing the angle generated by the sternum and the axis of the body at the most depressed plane of the sternum.
Figure 2.
Figure 2.
Modified Haller index. Axial CT scan showing positions for measuring. A = distance of the maximal inner transverse thoracic diameter. B = distance between the parallel line on the vertebra to the deepest point of the sternum at the most depressed plane of the sternum.
Figure 3.
Figure 3.
A 13-year-old male patient with syndromic scoliosis (Marfan syndrome) and pectus excavatum. He underwent anterior and posterior fusion surgery (T4/L4) after corrective surgery of the pectus excavatum. A. Preoperative: thoracic 49 degrees, main thoracolumbar 64 degrees of coronal curvature in A-P and lateral radiographs. B. Postoperative: thoracic 25 degrees, main thoracolumbar 21 degrees of coronal curvature in A-P and lateral radiographs.

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