TY - JOUR
T1 - Clinical significance of concomitant pectus deformity and adolescent idiopathic scoliosis
T2 - systematic review with best evidence synthesis
AU - van Es, Laurian J. M.
AU - van Royen, Barend J.
AU - Oomen, Matthijs W. N.
N1 - Funding Information: The authors would like to thank dr. R.J.J. van Es for his help. This is a systematic review offering an up-to-date overview of the association between idiopathic pectus deformities and adolescent idiopathic scoliosis. Predictive factors were presented according to a best-evidence synthesis. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request. BvR introduced the topic. LvE designed the review, collected the data, performed the analysis, and drafted the manuscript. MO and BvR reviewed the paper. Publisher Copyright: © 2022
PY - 2022/9/1
Y1 - 2022/9/1
N2 - 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.
AB - 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.
KW - Adolescent idiopathic scoliosis (AIS)
KW - Chest wall deformities
KW - Funnel chest
KW - Pectus carinatum
KW - Pectus excavatum
KW - Pigeon breast
KW - Scoliosis
UR - http://www.scopus.com/inward/record.url?scp=85133238019&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.xnsj.2022.100140
DO - https://doi.org/10.1016/j.xnsj.2022.100140
M3 - Review article
C2 - 35814492
SN - 2666-5484
VL - 11
JO - North American Spine Society Journal
JF - North American Spine Society Journal
M1 - 100140
ER -