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

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

doi:10.1016/j.xnsj.2022.100140

Cited by 6 publications

(8 citation statements)

References 66 publications

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“…14 Cases of non-syndromal PE can be considered to be an isolated anomaly, however it is usually accompanied by other thoracic cage deformities, congenital heart diseases, respiratory system defects, and underdeveloped chest muscles, that is, Poland syndrome. Like previous studies, 15,16 in our cohort, there were high rates of scoliosis (9.1%) and straight back syndrome (7.7%) associated with PE. The high prevalence (17.8%) of comorbidities supports the need for screening strategies for associated conditions in patients with PE.…”

Section: Discussionsupporting

confidence: 87%

Outcomes of the Nuss procedure in children with pectus excavatum: 14 years of experience

Chu,

Chang,

Yang

et al. 2024

Journal of the Chinese Medical Association

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Background: We aimed to assess the effectiveness of the Nuss procedure for pectus excavatum (PE) and explore the impacts of sex and age on outcomes. Methods: We retrospectively reviewed 594 consecutive children ≤ 18 years of age who underwent the thoracoscopy-assisted Nuss technique between January 2006 and July 2019. The severity of pectus deformity was calculated according to the Haller index (HI). The classification of PE and clinical data including complications were analyzed. Results: Of the 594 patients, 456 (76.8%) were boys and 138 (23.2%) were girls. The mean age at surgery was 10.0±5.0 years. The most common types of PE were 1A and 2A2 according to Park’s classification. Intraoperative and postoperative complication rates were 2/594 (0.3%) and 74/594 (12.5%), respectively. The most common complication was bar displacement. The bar was removed in 414 patients 3.5±0.8 years later. The mean preoperative HI, postoperative HI with bar, and HI after bar removal were 4.2±1.7, 2.4±0.3 and 2.7±0.5, respectively. Compared to the preoperative HI, both the postoperative HI with bar and HI after bar removal were significantly lower (p<0.001). For preschool-age children, the preoperative HI was significantly higher (p=0.027) and the change in HI significantly improved compared to school-age children (p=0.004). Boys and adolescents needed significantly more bars and stabilizers. Conclusion: Surgical correction of PE using the Nuss procedure is a safe procedure and improves the HI in children of different ages, even in those younger than 6 years of age.

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Section: Discussionsupporting

confidence: 87%

Outcomes of the Nuss procedure in children with pectus excavatum: 14 years of experience

Chu,

Chang,

Yang

et al. 2024

Journal of the Chinese Medical Association

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“…While pectus excavatum is often an isolated anomaly, as mentioned before, it can be associated with other musculoskeletal diseases, particularly scoliosis and connective tissue disorders (e.g., Marfan syndrome, Ehlers-Danlos syndrome) ( 72 , 91 - 93 ). The deformity has been associated with over 27 genetic conditions and even more genetic defects, which are thoroughly described along with their clinical signs in the reviews by Kotzot [2009] and Billar et al [2021] ( 86 , 94 ).…”

Section: Pectus Excavatummentioning

confidence: 97%

Pectus excavatum and carinatum: a narrative review of epidemiology, etiopathogenesis, clinical features, and classification

Janssen,

Coorens,

Franssen

et al. 2024

J Thorac Dis

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Background and Objective A wide variety of congenital chest wall deformities that manifest in infants, children and adolescents exists, among which are pectus excavatum and pectus carinatum. Numerous studies have been conducted over the years aiming to better understand these deformities. This report provides a brief overview of what is currently known about the epidemiology, etiopathogenesis, clinical presentation, and classification of these deformities, and highlights the gaps in knowledge. Methods A search was conducted for all the above-described domains in the PubMed and Embase databases. Key Content and Findings A total of 147 articles were included in this narrative review. Estimation of the true incidence and prevalence of pectus excavatum and carinatum is challenging due to lacking consensus on a definition of both deformities. Nowadays, several theories for the development of pectus excavatum and carinatum have been suggested which focus on intrinsic or extrinsic pathogenic factors, with the leading hypothesis focusing on overgrowth or growth disturbance of costal cartilages. Furthermore, genetic predisposition to the deformities is likely to exist. Pectus excavatum is frequently associated with cardiopulmonary symptoms, while pectus carinatum patients mostly present with cosmetic complaints. Both deformities are classified based on the shape or severity of the deformity. However, each classification system has its limitations. Conclusions Substantial progress has been made in the past few decades in understanding the development and symptomatology of pectus excavatum and carinatum. Current hypotheses on the etiology of the deformities should be confirmed by biomedical and genetic studies. For clinical purposes, the establishment of a clear definition and classification system for both deformities based on objective morphologic features is eagerly anticipated.

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“…Whether such asymmetry of muscles was present before puberty and only exacerbated by puberty and rapid growth has also been raised by Stepien et al (2022) and also elaborated on regarding potential embryonic origins has been suggested ( Burwell et al, 2016 ). The literature has also been reviewed that indicates that there is a correlation between pectus deformity and AIS ( Van Es et al, 2022 ). Interestingly, analysis of paravertebral muscles has indicated that potentially relevant molecular differences can also be detected with biopsies from AIS patients ( Rusin et al, 2012 ; Kudo et al, 2015 ).…”

Section: Sex Differences In Risk For Injury To Msk Tissues During Dev...mentioning

confidence: 99%

Sex differences in musculoskeletal injury and disease risks across the lifespan: Are there unique subsets of females at higher risk than males for these conditions at distinct stages of the life cycle?

Hart

2023

Front. Physiol.

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Sex differences have been reported for diseases of the musculoskeletal system (MSK) as well as the risk for injuries to tissues of the MSK system. For females, some of these occur prior to the onset of puberty, following the onset of puberty, and following the onset of menopause. Therefore, they can occur across the lifespan. While some conditions are related to immune dysfunction, others are associated with specific tissues of the MSK more directly. Based on this life spectrum of sex differences in both risk for injury and onset of diseases, a role for sex hormones in the initiation and progression of this risk is somewhat variable. Sex hormone receptor expression and functioning can also vary with life events such as the menstrual cycle in females, with different tissues being affected. Furthermore, some sex hormone receptors can affect gene expression independent of sex hormones and some transitional events such as puberty are accompanied by epigenetic alterations that can further lead to sex differences in MSK gene regulation. Some of the sex differences in injury risk and the post-menopausal disease risk may be “imprinted” in the genomes of females and males during development and sex hormones and their consequences only modulators of such risks later in life as the sex hormone milieu changes. The purpose of this review is to discuss some of the relevant conditions associated with sex differences in risks for loss of MSK tissue integrity across the lifespan, and further discuss several of the implications of their variable relationship with sex hormones, their receptors and life events.

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

Cited by 6 publications

References 66 publications

Outcomes of the Nuss procedure in children with pectus excavatum: 14 years of experience

Outcomes of the Nuss procedure in children with pectus excavatum: 14 years of experience

Pectus excavatum and carinatum: a narrative review of epidemiology, etiopathogenesis, clinical features, and classification

Sex differences in musculoskeletal injury and disease risks across the lifespan: Are there unique subsets of females at higher risk than males for these conditions at distinct stages of the life cycle?

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