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General Thoracic and Cardiovascular Surgery
Published in: General Thoracic and Cardiovascular Surgery 11/2020

01-11-2020 | Scoliosis | Review Article

Pectus excavatum and scoliosis: a review about the patient’s surgical management

Authors: Eleftherios T. Beltsios, Sofoklis L. Mitsos, Nikolaos T. Panagiotopoulos

Published in: General Thoracic and Cardiovascular Surgery | Issue 11/2020

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Abstract

Although Nuss procedure is performed with satisfactory results, there has been a controversy in the literature regarding the effect of a Nuss procedure on the spine. This review article aims to perform an updated overview of the literature about the effect of pectus excavatum correction at the spine and the management of patients with both pectus excavatum and scoliosis. Although acquired scoliosis has been rarely reported after a Nuss procedure, studies show that the Nuss procedure can have a beneficial effect in mild coexisting scoliosis especially when it is performed during the adolescence. The management of cases presented with both pectus excavatum and scoliosis depends on the severity of pre-operative scoliosis and demands detailed evaluation of the spine pre and postoperatively. In the rare condition of post-operative scoliosis following a Nuss procedure, the removal of the metallic bar and conservative measures may have satisfactory results on the spine.
Literature
1.
Marks MW, Iacobucci J. Reconstruction of congenital chest wall deformities using solid silicone onlay prostheses. Chest Surg Clin N Am. 2000;10(2):341–55 (vii).PubMed
2.
Fibla JJ, Molins L. Minimally invasive treatment of pectus excavatum. Minerva Chir. 2016;71(1):38–45.PubMed
3.
Shamberger RC. Congenital chest wall deformities. Curr Probl Surg. 1996;33(6):469–54242.PubMed
4.
Fonkalsrud EW. Current management of pectus excavatum. World J Surg. 2003;27(5):502–8.PubMed
5.
Kuru P, Bostanci K, Ermerak NO, et al. Quality of life improves after minimally invasive repair of pectus excavatum. Asian Cardiovasc Thorac Ann. 2015;23(3):302–7.PubMed
6.
Ghionzoli M, Martin A, Bongini M, et al. Scoliosis and pectus excavatum in adolescents: does the Nuss procedure affect the scoliotic curvature? J Laparoendosc Adv Surg Tech A. 2016;26(9):734–9.PubMed
7.
Wang Y, Chen G, Xie L, et al. Mechanical factors play an important role in pectus excavatum with thoracic scoliosis. J Cardiothorac Surg. 2012;7:118.PubMedPubMedCentral
8.
Nakaoka T, Uemura S, Yano T, et al. Does overgrowth of costal cartilage cause pectus excavatum? A study on the lengths of ribs and costal cartilages in asymmetric patients. J Pediatr Surg. 2009;44(7):1333–6.PubMed
9.
Park CH, Kim TH, Haam SJ, Lee S. Rib overgrowth may be a contributing factor for pectus excavatum: Evaluation of prepubertal patients younger than 10years old. J Pediatr Surg. 2015;50(11):1945–8.PubMed
10.
Kondo S, Takagi D, Osaga S, et al. The costochondral length in patients with pectus excavatum is longer than that of the normal thorax. Pediatr Surg Int. 2020;36(3):305–16.PubMed
11.
Sharma G, Carter YM. Pectus excavatum. StatPearls. Treasure Island: StatPearls Publishing; 2019.
12.
Gokhale J, Selbst SM. Chest pain and chest wall deformity. Pediatr Clin N Am. 2009;56(1):49–65 (x).
13.
Felts E, Jouve J-L, Blondel B, et al. Child pectus excavatum: correction by minimally invasive surgery. Orthop Traumatol Surg Res OTSR. 2009;95(3):190–5.PubMed
14.
Iida H. Surgical repair of pectus excavatum. Gen Thorac Cardiovasc Surg. 2010;58(2):55–61.PubMed
15.
Robicsek F, Watts LT, Fokin AA. Surgical repair of pectus excavatum and carinatum. Semin Thorac Cardiovasc Surg. 2009;21(1):64–75.PubMed
16.
Nuss D, Kelly RE, Croitoru DP, Katz ME. A 10-year review of a minimally invasive technique for the correction of pectus excavatum. J Pediatr Surg. 1998;33(4):545–52.PubMed
17.
Nuss D, Kelly RE. Minimally invasive surgical correction of chest wall deformities in children (Nuss procedure). Adv Pediatr. 2008;55:395–410.PubMed
18.
Prats MR, González LR, Venturelli MF, et al. Minimally invasive correction of pectus excavatum among adults. Report of eighteen cases. Rev Med Chil. 2009;137(12):1583–90.
19.
Kuenzler KA, Stolar CJH. Surgical correction of pectus excavatum. Paediatr Respir Rev. 2009;10(1):7–11.PubMed
20.
Hanna WC, Ko MA, Blitz M, et al. Thoracoscopic Nuss procedure for young adults with pectus excavatum: excellent midterm results and patient satisfaction. Ann Thorac Surg. 2013;96(3):1033–6 (discussion 1037-1038).PubMed
21.
Ewais MM, Chaparala S, Uhl R, Jaroszewski DE. Outcomes in adult pectus excavatum patients undergoing Nuss repair. Patient Relat Outcome Meas. 2018;9:65–90.PubMedPubMedCentral
22.
Robicsek F, Hebra A. To nuss or not to nuss? Two opposing views. Semin Thorac Cardiovasc Surg. 2009;21(1):85–8.PubMed
23.
Mao YZ, Tang S, Li S. Comparison of the Nuss versus Ravitch procedure for pectus excavatum repair: an updated meta-analysis. J Pediatr Surg. 2017;52(10):1545–52.PubMed
24.
Mavanur A, Hight DW. Pectus excavatum and carinatum: new concepts in the correction of congenital chest wall deformities in the pediatric age group. Conn Med. 2008;72(1):5–11.PubMed
25.
26.
27.
Buziashvili D, Gopman JM, Weissler H, et al. An evidence-based approach to management of pectus excavatum and carinatum. Ann Plast Surg. 2019;82(3):352–8.PubMed
28.
Swanson JW, Avansino JR, Phillips GS, et al. Correlating Haller Index and cardiopulmonary disease in pectus excavatum. Am J Surg. 2012;203(5):660–4.PubMed
29.
Haller JA, Kramer SS, Lietman SA. Use of CT scans in selection of patients for pectus excavatum surgery: a preliminary report. J Pediatr Surg. 1987;22(10):904–6.PubMed
30.
Poston PM, Patel SS, Rajput M, et al. The correction index: setting the standard for recommending operative repair of pectus excavatum. Ann Thorac Surg. 2014;97(4):1176–9 (discussion 1179-1180).PubMed
31.
Sujka JA, St Peter SD. Quantification of pectus excavatum: anatomic indices. Semin Pediatr Surg. 2018;27(3):122–6.PubMed
32.
Fagelman KM, Methratta S, Cilley RE, et al. The Depression Index: an objective measure of the severity of pectus excavatum based on vertebral diameter, a morphometric correlate to patient size. J Pediatr Surg. 2015;50(7):1130–3.PubMed
33.
de Araújo MEA, da Penha AP, Westphal FL, et al. Nuss procedure for pectus excavatum repair: critical appraisal of the evidence. Rev Col Bras Cir. 2014;41(6):400–5.PubMed
34.
Lopushinsky SR, Fecteau AH. Pectus deformities: a review of open surgery in the modern era. Semin Pediatr Surg. 2008;17(3):201–8.PubMed
35.
Park HJ, Sung S-W, Park J-K, et al. How early can we repair pectus excavatum: the earlier the better? Eur J Cardio-Thorac Surg Off J Eur Assoc Cardio-Thorac Surg. 2012;42(4):667–72.
36.
Pawlak K, Gąsiorowski Ł, Gabryel P, et al. Early and late results of the Nuss procedure in surgical treatment of pectus excavatum in different age groups. Ann Thorac Surg. 2016;102(5):1711–6.PubMed
37.
Park HJ, Kim JJ, Park JK, Moon SW. Effects of Nuss procedure on thoracic scoliosis in patients with pectus excavatum. J Thorac Dis. 2017;9(10):3810–6.PubMedPubMedCentral
38.
Kim DH, Hwang JJ, Lee MK, et al. Analysis of the Nuss procedure for pectus excavatum in different age groups. Ann Thorac Surg. 2005;80(3):1073–7.PubMed
39.
Protopapas AD, Athanasiou T. Peri-operative data on the Nuss procedure in children with pectus excavatum: independent survey of the first 20 years’ data. J Cardiothorac Surg. 2008;3:40.PubMedPubMedCentral
40.
Esteves E, Paiva KCC, Calcagno-Silva M, et al. Treatment of pectus excavatum in patients over 20 years of age. J Laparoendosc Adv Surg Tech A. 2011;21(1):93–6.PubMed
41.
Ravenni G, Actis Dato GM, Zingarelli E, et al. Nuss procedure in adult pectus excavatum: a simple artifice to reduce sternal tension. Interact Cardiovasc Thorac Surg. 2013;17(1):23–5.PubMedPubMedCentral
42.
Velazco CS, Arsanjani R, Jaroszewski DE. Nuss procedure in the adult population for correction of pectus excavatum. Semin Pediatr Surg. 2018;27(3):161–9.PubMed
43.
Densmore JC, Peterson DB, Stahovic LL, et al. Initial surgical and pain management outcomes after Nuss procedure. J Pediatr Surg. 2010;45(9):1767–71.PubMed
44.
Futagawa K, Suwa I, Okuda T, et al. Anesthetic management for the minimally invasive Nuss procedure in 21 patients with pectus excavatum. J Anesth. 2006;20(1):48–50.PubMed
45.
Muhly WT, Beltran RJ, Bielsky A, et al. Perioperative management and in-hospital outcomes after minimally invasive repair of pectus excavatum: a multicenter registry report from the society for pediatric anesthesia improvement network. Anesth Analg. 2019;128(2):315–27.PubMed
46.
Bouchard S, Hong AR, Gilchrist BF, Kuenzler KA. Catastrophic cardiac injuries encountered during the minimally invasive repair of pectus excavatum. Semin Pediatr Surg. 2009;18(2):66–72.PubMed
47.
Park HJ, Lee SY, Lee CS, et al. The Nuss procedure for pectus excavatum: evolution of techniques and early results on 322 patients. Ann Thorac Surg. 2004;77(1):289–95.PubMed
48.
Shah M, Frye R, Marzinsky A, et al. Complications associated with bar fixation following Nuss repair for pectus excavatum. Am Surg. 2016;82(9):781–2.PubMedPubMedCentral
49.
Johnson JN, Hartman TK, Pianosi PT, Driscoll DJ. Cardiorespiratory function after operation for pectus excavatum. J Pediatr. 2008;153(3):359–64.PubMed
50.
Chen Z, Amos EB, Luo H, et al. Comparative pulmonary functional recovery after Nuss and Ravitch procedures for pectus excavatum repair: a meta-analysis. J Cardiothorac Surg. 2012;7(1):1–9.
51.
Zhong W, Ye J, Feng J, et al. Effects of pectus excavatum on the spine of pectus excavatum patients with scoliosis. J Healthc Eng. 2017;2017:5048625.PubMedPubMedCentral
52.
53.
Hong J-Y, Suh S-W, Park H-J, et al. Correlations of adolescent idiopathic scoliosis and pectus excavatum. J Pediatr Orthop. 2011;31(8):870–4.PubMed
54.
Frick SL. Scoliosis in children with anterior chest wall deformities. Chest Surg Clin N Am. 2000;10(2):427–36.PubMed
55.
Waters P, Welch K, Micheli LJ, et al. Scoliosis in children with pectus excavatum and pectus carinatum. J Pediatr Orthop. 1989;9(5):551–6.PubMed
56.
Niedbala A, Adams M, Boswell WC, Considine JM. Acquired thoracic scoliosis following minimally invasive repair of pectus excavatum. Am Surg. 2003;69(6):530–3.PubMed
57.
Ye J-D, Lu G-P, Feng J-J, Zhong W-H. Effect on chest deformation of simultaneous correction of pectus excavatum with scoliosis. J Healthc Eng. 2017;2017:8318694.PubMedPubMedCentral
58.
Tomaszewski R, Wiktor Ł, Machała L. Evaluation of thoracic vertebrae rotation in patients with pectus excavatum. Acta Orthop Traumatol Turc. 2017;51(4):284–9.PubMedPubMedCentral
59.
Negrini S, Donzelli S, Aulisa AG, et al. 2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis Spinal Disord. 2018;13:3.PubMedPubMedCentral
60.
SOSORT guideline committee, Weiss H-R, Negrini S, et al. Indications for conservative management of scoliosis (guidelines). Scoliosis. 2006;1:5.PubMedCentral
61.
Bafus BT, Chiravuri D, van der Velde ME, et al. Severe hypotension associated with the prone position in a child with scoliosis and pectus excavatum undergoing posterior spinal fusion. J Spinal Disord Tech. 2008;21(6):451–4.PubMed
62.
Chung JH, Park HJ, Kim KT. Scoliosis after pectus excavatum correction: does it improve or worsen? Eur J Cardio-Thorac Surg. 2017;52(1):76–82.
63.
Tauchi R, Kawakami N, Tsuji T, et al. Evaluation of thoracic factors after scoliosis surgery in patients with both scoliosis and pectus excavatum. Eur Spine J. 2018;27(2):381–7.PubMed
64.
Metadata
Title
Pectus excavatum and scoliosis: a review about the patient’s surgical management
Authors
Eleftherios T. Beltsios
Sofoklis L. Mitsos
Nikolaos T. Panagiotopoulos
Publication date
01-11-2020
Publisher
Springer Singapore
Keyword
Scoliosis
Published in
General Thoracic and Cardiovascular Surgery / Issue 11/2020
Print ISSN: 1863-6705
Electronic ISSN: 1863-6713
DOI
https://doi.org/10.1007/s11748-020-01496-y

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