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

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.

Figure 1

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