Evaluation of thoracic vertebrae rotation in patients with pectus excavatum

Abstract

PurposeThe aim of our study was to evaluate thoracic vertebrae rotation in patients with pectus excavatum. Moreover, we wanted to assess the prevalence, the severity and relationship between pectus excavatum and adolescent idiopathic scoliosis (AIS).MethodsWe performed retrospective analysis of 82 preoperative chest CT in children with pectus excavatum performed between January 2008 and December 2011. For each patient Haller Index and Cobb angle was measured. To evaluate the severity of thoracic scoliosis we measured vertebral rotation for Th8 and for vertebra at the level of highest chest deformation using Aaro-Dahlborn method.ResultsFrom the group of 54 patients with pectus excavatum enrolled in the study AIS was diagnosed in 8 patients (14,81%). In patients with symmetric deformation, Th8 rotation was found in 21 patients; the rotation of the apical vertebra was found in 20 patients. In patients with asymmetric deformation Th8 rotation was found in 10 patients; the rotation of the apical vertebra was found in 8 patients.Conclusions1. We have confirmed the higher prevalence of pectus excavatum in boys; 2. We have found a significant relationship between pectus excavatum and adolescent idiopathic scoliosis; 3. We have shown that deformation of the anterior chest wall enforces rotation of the thoracic spine; 4. We haven't found the relationship between the severity of the chest deformity (HI measured) and severity of AIS (Cobb angle measured); 5. We have shown a significant association between HI measured and rotation of thoracic vertebra at the level of highest chest deformation (apical vertebra) in symmetric pectus excavatum.Level of evidence: Level IV, Diagnostic study.

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

“…One study was identified by backward citation. Eventually, 48 studies were included: 19 in category I [ 5 , 9 , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] ], 21 in category II [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , and 8 in category III [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] ( Figure 1 ).

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

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“…Nineteen studies focused on the association between PD and scoliosis, of which 4 described cases [ 9 , 20 , 24 , 27 ], 5 described spinal change after PD correction [ 19 , 21 , 23 , 25 , 26 ], and 2 PD change after scoliosis correction [ 17 , 28 ]. Thirteen studies analyzed predictive factors [ 5 , 16 , 18 , 19 , [21] , [22] , [23] , 25 , 26 , [29] , [30] , [31] , [32] ], of which three solely included patients with PD-associated scoliosis [ 25 , 29 , 32 ] (Appendix B). Five of these 13 studies did not describe inclusion criteria regarding either scoliosis or syndromic cases [ 16 , 18 , 23 , 25 , 32 ].…”

“…Combining categories I and II, 31 studies reported a prevalence of scoliosis in PD populations (Appendix C). In all, 19 comprised solely PE cases [ 18 , 19 , [21] , [22] , [23] , 26 , 30 , 31 , 34 , 36 , [38] , [39] , [40] , [41] , [42] , 45 , 47 , 49 , 50 ], 2 solely PC cases [ 35 , 44 ], and 6 analyzed PE and PC separately [ 5 , 16 , 35 , 43 , 46 , 51 , 52 ]. Fourteen studies described definitions of scoliosis or its diagnostic measures [ 5 , 18 , 19 , 22 , 23 , 26 , 30 , 31 , 33 , 34 , 40 , 47 , 52 , 53 ], 9 involved an entire idiopathic population [ 16 , 19 , 22 , 26 , 30 , 31 , 34 , 41 , 51 , 52 ], and 1 a non-surgical one [53] .…”

“…All studies reported a significantly higher prevalence of scoliosis in PD patients as compared to the general population. Most PD-associated AIS involved single curves of the middle to lower thoracic spine (Lenke type 1) [ 5 , 22 , [29] , [30] , [31] ]. Regarding convexity (right- versus left-sided scoliotic curve), the literature was contradictory [ 21 , 31 ].…”

The Effect of Physical Activity on Pulmonary Function In Patients With Pectus Excavatum

“…Omaník et al [45] and Kokavec and Novorolský [46] report that more than 20% of patients with pectus excavatum also have associated idiopathic scoliosis or spinal kyphoscoliosis. Tomaszewski et al [47] have shown that deformation of the anterior thoracic wall promotes rotation of the thoracic spine. Our study did not show a statistically significant difference in physical activity levels in groups of subjects depending on chest deformity.…”