Scoliosis and Pectus Excavatum in Adolescents: Does the Nuss Procedure Affect the Scoliotic Curvature?

Abstract

In our PE patients with AIS, MIRPE had a beneficial effect also on the spine. From our preliminary results, it seems that MIRPE should be offered during puberty as a timely option for treating PE and stabilizing mild/moderate scoliosis progression, when concurrent.

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] .…”

“…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 ]. One study reported a significant association between PE severity and the rotation degree of thoracic vertebrae [30] .…”

“…The cases that showed progression warranted scoliosis surgery 3 months after the Nuss procedure [20] . Additionally, 2 cohort studies reported a postoperative increase of CA in 1.1% to 4.5% of cases [ 21 , 42 ].…”