Spinal deformities and other orthopedic disorders in children with pectus carinatum

Abstract

BACKGROUND: Owing to its clear clinical manifestation, pectus carinatum is often the reason for the initial visit to the doctor of children with several concomitant orthopedic abnormalities.

AIM: To identify concomitant orthopedic disorders in children with pectus carinatum and assess their frequency, clinical manifestations, and relationships with various modifiable and non-modifiable factors.

MATERIALS AND METHODS: This observational, single-center, cross-sectional study included 147 patients aged 5–17 years with pectus carinatum. Orthopedic examination and radiography of the spine were performed. Categorical values were described by reporting absolute values and percentages in the sample and quantitatively using arithmetic averages and standard deviations. The Student’s T-test and Chi-square coefficient were used for assessing the relationship (p < 0.05).

RESULTS: In 3/147 (2.0%) children, pectus carinatum was a symptom of genetically confirmed Marfan syndrome. Among 147 children with pectus carinatum, 56 (38.1%) complained of back pain, 125 (85.0%) had a mobile plano-valgus foot, and 108 (73.5%) had postural disorders. Scheuermann disease was detected in 22 (15.0%) children and signs of spinal osteochondrosis in 57 (38.8%). Back pain was associated with sclerosis/usuration of the vertebral end plates. Children who regularly engaged in sports involving forceful load on the back muscles complained of pain less often, regardless of the degree of spine deformity.

CONCLUSIONS: Mobile flat foot, sagittal component of posture disorders, and spinal osteochondrosis are common in children with pectus carinatum. Thus, children with keel chest deformity should undergo orthopedic examination and spinal X-ray in a standing position. Because of the high incidence of back pain and its association with insufficient muscular frame development, children with pectus carinatum are recommended to regularly engage in physical therapy and/or sports associated with loads on the back muscles.

Keywords

pectus carinatum / posture / spinal osteochondrosis / Scheuermann disease / back pain

References

[1] Kolvekar SK, Pilegaard HK. Chest Wall Deformities and Corrective Procedures. Switzerland: Springer International Publishing; 2016. 170 p. doi: 10.1007/978-3-319-23968-2

[2] Kolvekar S.K., Pilegaard H.K. Chest Wall Deformities and Corrective Procedures. Switzerland: Springer International Publishing, 2016. 170 p. doi: 10.1007/978-3-319-23968-2

[3] Alaca N, Yüksel M. Comparison of physical functions and psychosocial conditions between adolescents with pectus excavatum, pectus carinatum and healthy controls. Pediatr Surg Int. 2021;37(6):765–75. doi: 10.1007/s00383-021-04857-7

[4] Alaca N., Yüksel M. Comparison of physical functions and psychosocial conditions between adolescents with pectus excavatum, pectus carinatum and healthy controls // Pediatr Surg Int. 2021. Vol. 37, № 6. P. 765–75. doi: 10.1007/s00383-021-04857-7

[5] Loeys BL, Dietz HC, Braverman AC, et al. The revised Ghent nosology for the Marfan syndrome. J Med Genet. 2010;47(7):476–85. doi: 10.1136/jmg.2009.072785

[6] Loeys B.L., Dietz H.C., Braverman A.C., et al. The revised Ghent nosology for the Marfan syndrome // J Med Genet. 2010. Vol. 47, № 7. P. 476–485. doi: 10.1136/jmg.2009.072785

[7] Abbakumova LN, Arsentev VG, Gnusaev SF, et al. Multifactorial and hereditary connective tissue disorders in children. Diagnostic algorithms. Management tactics. Russia guidelines. Pediatrician. 2016;7(2):5–39. (In Russ). doi: 10.17816/PED725-39

[8] Аббакумова Л.Н., Арсентьев В.Г., Гнусаев С.Ф., и др. Наследственные и многофакторные нарушения соединительной ткани у детей. Алгоритмы диагностики. Тактика ведения. Российские рекомендации // Педиатр. 2016. № 2. С. 5–39. doi: 10.17816/PED725-39

[9] Alaca N, Alaca İ, Yüksel M. Does physiotherapy applied in conjunction with compression brace treatment in patients with pectus carinatum have efficacy? A preliminary randomized-controlled study. Pediatr Surg Int. 2020;36(7):789–97. doi: 10.1007/s00383-020-04675-3

[10] Alaca N., Alaca İ., Yüksel M. Does physiotherapy applied in conjunction with compression brace treatment in patients with pectus carinatum have efficacy? A preliminary randomized-controlled study // Pediatr Surg Int. 2020. Vol. 36, № 7. P. 789–97. doi: 10.1007/s00383-020-04675-3

[11] Desmarais TJ, Keller MS. Pectus carinatum. Curr Opin Pediatr. 2013;25(3):375–81. doi: 10.1097/MOP.0b013e3283604088

[12] Desmarais T.J., Keller M.S. Pectus carinatum // Curr Opin Pediatr. 2013. Vol. 25, № 3. P. 375–381. doi: 10.1097/MOP.0b013e3283604088

[13] Haje SA, de Podestá Haje D. Orthopedic approach to pectus deformities: 32 years of studies. Rev Bras Ortop. 2009;44(3):191–8. doi: 10.1016/S2255-4971(15)30067-7

[14] Haje S.A., de Podestá Haje D. Orthopedic approach to pectus deformities: 32 years of studies // Rev Bras Ortop. 2009. Vol. 44, № 3. P. 191–198. doi: 10.1016/S2255-4971(15)30067-7

[15] Vorobyeva EA, Razumovskiy AYu, Dubrov VE, et al. Сombination of pectus carinatum and Scheuermann-Mau disease in children: an empirical pattern or somite syndrome? Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2023;13(1):13–24. doi: https://doi.org/10.17816/psaic1491

[16] Воробьёва Е.А., Разумовский А.Ю., Дубров В.Э., и др. Сочетание килевидной деформации грудной клетки и болезни Шейермана — Мау у детей: эмпирическая закономерность или сомитный синдром // Российский вестник детской хирургии, анестезиологии и реаниматологии. 2023. Т. 13, № 1. С. 13–24. doi: 10.17816/psaic1491

[17] Magee DJ, Manske RC. Orthopedic physical assessment. 7th ed. St. Louis, Missouri: Elsevier; 2021. 1549 p.

[18] Magee D.J., Manske R.C. Orthopedic physical assessment. 7th ed. Missouri: Elsevier, 2021. doi: 10.17816/psaic1491

[19] Mitskevich VA. Orthopedics of the first steps. 5th ed. Moscow: BINOM. Laboratoriya znanii; 2021. 359 p. (In Russ).

[20] Мицкевич В.А. Ортопедия первых шагов. 5-е изд. Москва: БИНОМ. Лаборатория знаний, 2021. 359 с.

[21] Vialle R, Levassor N, Rillardon L, et al. Radiographic analysis of the sagittal alignment and balance of the spine in asymptomatic subjects. J Bone Joint Surg Am. 2005;87(2):260–7. doi: 10.2106/JBJS.D.02043

[22] Vialle R., Levassor N., Rillardon L., et al. Radiographic analysis of the sagittal alignment and balance of the spine in asymptomatic subjects // J Bone Joint Surg Am. 2005. Vol. 87, № 2. P. 260–267. doi: 10.2106/JBJS.D.02043

[23] Schlösser TP, Vincken KL, Rogers K, et al. Natural sagittal spino-pelvic alignment in boys and girls before, at and after the adolescent growth spurt. Eur Spine J. 2015;24(6):1158–67. doi: 10.1007/s00586-014-3536-z

[24] Schlösser T.P., Vincken K.L., Rogers K., et al. Natural sagittal spino-pelvic alignment in boys and girls before, at and after the adolescent growth spurt // Eur Spine J. 2015. Vol. 24, № 6. P. 1158–1167. doi: 10.1007/s00586-014-3536-z

[25] Ulrih EV, Mushkin AYu. Vertebrology in terms, figures and drawings. Saint Petersburg: ELBI-SPb; 2002. 187 p. (In Russ). EDN: VTGEGN

[26] Ульрих Э.В., Мушкин А.Ю. Вертебрология в терминах, цифрах и рисунках. Санкт-Петербург: ЭЛБИ-СПб, 2002. 187 c. EDN: VTGEGN

[27] Mihaylovskiy N.V.; Russian assosiation of trauma and ortopedic susgeons. Scheuermann desease. Clinical guidelines [Internet]. Novosibirsk; 2013. 27 p. [cited 2023 Oct 24]. Available from: https://view.officeapps.live.com/op/view.aspx?src=http%3A%2F%2Ffiles.cito-priorov.ru%2Fcito%2Fkr_association%2F%25D0%2591%25D0%25BE%25D0%25BB%25D0%25B5%25D0%25B7%25D0%25BD%25D1%258C%2520%25D0%25A8%25D0%25BE%25D0%25B9%25D0%25B5%25D1%2580%25D0%25BC%25D0%25B0%25D0%25BD%25D0%25B0-%25D0%259C%25D0%25B0%25D1%2583.doc&wdOrigin=BROWSELINK (In Russ).

[28] Михайловский Н.В.; Общероссийская общественная организация «Ассоциация травматологов-ортопедов России». Болезнь Шойермана–Мау. Клинические рекомендации [Internet]. Новосибирск, 2013. 27 с. Дата обращения: 24.10.2023. Режим доступа: https://view.officeapps.live.com/op/view.aspx?src=http%3A%2F%2Ffiles.cito-priorov.ru%2Fcito%2Fkr_association%2F%25D0%2591%25D0%25BE%25D0%25BB%25D0%25B5%25D0%25B7%25D0%25BD%25D1%258C%2520%25D0%25A8%25D0%25BE%25D0%25B9%25D0%25B5%25D1%2580%25D0%25BC%25D0%25B0%25D0%25BD%25D0%25B0-%25D0%259C%25D0%25B0%25D1%2583.doc&wdOrigin=BROWSELINK

[29] Legaye J, Duval-Beaupère G, Hecquet J, Marty C. Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves. Eur Spine J. 1998;7(2):99–103. doi: 10.1007/s005860050038

[30] Legaye J., Duval-Beaupère G., Hecquet J., et al. Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves // Eur Spine J. 1998. Vol. 7, № 2. P. 99–103. doi: 10.1007/s005860050038

[31] Lovell WW, Winter RB, Morrissy RT, Weinstein SL. Lovell and Winter’s pediatric orthopaedics. Philadelphia: Lippincott Williams & Wilkins; 2006.

[32] Lovell W.W., Winter R.B., Morrissy R.T., Weinstein S.L. Lovell and Winter’s pediatric orthopaedics. Philadelphia: Lippincott Williams & Wilkins, 2006. 1545 p.

[33] WHO [Internet]. Growth reference data for 5–19 years [updated 2007; cited 24 Oct 2023]. Availible from: WHO. toolsgrowth-reference-data-for-5to19-years 2007

[34] WHO [Internet]. Growth reference data for 5–19 years; 2007. Дата обращения: 20.10.2023. Режим доступа: WHO. toolsgrowth-reference-data-for-5to19-years 2007

[35] White SE. Basic & Clinical Biostatistics. 5th ed. New York: McGraw-Hill Education; 2020.

[36] White S.E. Basic & Clinical Biostatistics. 5th ed. New York: McGraw-Hill Education, 2020. 368 p.

[37] Lawan A, Crites Videman J, Battié MC. The association between vertebral endplate structural defects and back pain: a systematic review and meta-analysis. Eur Spine J. 2021;30(9):2531–48. doi: 10.1007/s00586-021-06865-6

[38] Lawan A., Crites V.J., Battié M.C. The association between vertebral endplate structural defects and back pain: a systematic review and meta-analysis // Eur Spine J. 2021. Vol. 30, № 9. P. 2531–2548. doi: 10.1007/s00586-021-06865-6

[39] Alagheband SJ, Clapp AD, Narducci DM, Cudahy R, Pujalte G. Limbus Vertebra. Cureus. 2021;13(3):e13954. doi: 10.7759/cureus.13954

[40] Alagheband S.J., Clapp A.D., Narducci D.M., et al. Limbus Vertebra // Cureus. 2021. Vol. 13, № 3. Р. e13954. doi: 10.7759/cureus.13954

[41] Sanal HT, Yilmaz S, Simsek I. Limbus vertebra. Arthritis Rheum. 2012;64(12):4011. doi: 10.1002/art.34630

[42] Sanal H.T., Yilmaz S., Simsek I. Limbus vertebra // Arthritis Rheum. 2012. Vol. 64, № 12. P. 4011. doi: 10.1002/art.34630

[43] Hasler CC. Back pain during growth. Swiss Med Wkly. 2013;143:w13714. doi: 10.4414/smw.2013.13714

[44] Hasler C.C. Back pain during growth // Swiss Med Wkly. 2013. Vol. 143. Р. w13714. doi: 10.4414/smw.2013.13714

[45] Smith A, O’Sullivan P, Straker L. Classification of sagittal thoraco-lumbo-pelvic alignment of the adolescent spine in standing and its relationship to low back pain. Spine (Phila Pa 1976). 2008;33(19):2101–7. doi: 10.1097/BRS.0b013e31817ec3b0

[46] Smith A., O’Sullivan P., Straker L. Classification of sagittal thoraco-lumbo-pelvic alignment of the adolescent spine in standing and its relationship to low back pain // Spine (Phila Pa 1976). 2008. Vol. 33, № 19. P. 2101–2107. doi: 10.1097/BRS.0b013e31817ec3b0

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