Interdisciplinary cardiovascular and thoracic surgery · 2026
Effect of Minimally Invasive Pectus Correction on Thoracic Spinal Alignment in Pectus Excavatum and Carinatum Patients: A Retrospective Cohort Study.
СтатьяНазвание и аннотация: Перевод в очереди
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Aydemir Selahaddin, Mutlu Fatma, Akin Eren, Karci Emrah, Karacam Volkan, Akcali Omer
Аннотация
OBJECTIVES: To evaluate segmental changes in thoracic spinal alignment following minimally invasive bar correction in patients with pectus excavatum (PE) and pectus carinatum (PC), and to determine the relationship between these changes in upper thoracic (UT, T1-T6) and main thoracic (MT, T6-T12) curvatures and relevant clinical or surgical factors.
METHODS: We retrospectively reviewed 581 patients operated in 2008-2020: 433 PE (Nuss) and 148 PC (Abramson). UT and MT Cobb angles were measured on PA chest radiographs preoperatively and at early/final postoperative follow-up. Age, sex, number of bars (1, 2, ≥3), lateral stabilizers, and retention time were recorded. Pre- vs postoperative differences were tested with paired t-tests; intersegment and covariate associations with Pearson correlation (P < .05).
RESULTS: Age was 17.1 ± 4.9 (PE) and 16.6 ± 7.9 (PC). In PE, UT/MT angles rose from 7.12°/7.03° (95% CI, 7.01°-8.98°/6.29°-8.33°) to 8.47°/7.20° (95% CI, 8.43°-10.67°/6.23°-8.43°); UT increased in 79.2% and MT in 49.2%. In PC, UT rose from 4.5° (95% CI, -1.47° to 18.41°) to 6.73°(95% CI, -2.22° to 22.39°), while MT fell from 10.02° (95% CI, 1.45°-12.38°) to 9.97° (95% CI, 3.26°-15.33°); UT increased in 81.1% and MT decreased in 93.2%. These changes were not significant overall (all P > .05). No associations were found between UT/MT changes and bar number, stabilizer use/orientation, or retention time. In PE, UT and MT changes correlated weakly but significantly (r = 0.205, P = .006); in PC, a moderate, non-significant correlation was observed (r = 0.515, P = .295).
CONCLUSIONS: Minimally invasive pectus correction can influence thoracic alignment not only in the main curvature but also in the UT segment. In patients with PE, postoperative increases in UT curvature may result in mild shoulder imbalance rather than true skeletal asymmetry. Therefore, pre- and postoperative clinical evaluation of shoulder level and posture should be included in the routine assessment of pectus patients to better understand and anticipate these segment-specific alignment changes.
METHODS: We retrospectively reviewed 581 patients operated in 2008-2020: 433 PE (Nuss) and 148 PC (Abramson). UT and MT Cobb angles were measured on PA chest radiographs preoperatively and at early/final postoperative follow-up. Age, sex, number of bars (1, 2, ≥3), lateral stabilizers, and retention time were recorded. Pre- vs postoperative differences were tested with paired t-tests; intersegment and covariate associations with Pearson correlation (P < .05).
RESULTS: Age was 17.1 ± 4.9 (PE) and 16.6 ± 7.9 (PC). In PE, UT/MT angles rose from 7.12°/7.03° (95% CI, 7.01°-8.98°/6.29°-8.33°) to 8.47°/7.20° (95% CI, 8.43°-10.67°/6.23°-8.43°); UT increased in 79.2% and MT in 49.2%. In PC, UT rose from 4.5° (95% CI, -1.47° to 18.41°) to 6.73°(95% CI, -2.22° to 22.39°), while MT fell from 10.02° (95% CI, 1.45°-12.38°) to 9.97° (95% CI, 3.26°-15.33°); UT increased in 81.1% and MT decreased in 93.2%. These changes were not significant overall (all P > .05). No associations were found between UT/MT changes and bar number, stabilizer use/orientation, or retention time. In PE, UT and MT changes correlated weakly but significantly (r = 0.205, P = .006); in PC, a moderate, non-significant correlation was observed (r = 0.515, P = .295).
CONCLUSIONS: Minimally invasive pectus correction can influence thoracic alignment not only in the main curvature but also in the UT segment. In patients with PE, postoperative increases in UT curvature may result in mild shoulder imbalance rather than true skeletal asymmetry. Therefore, pre- and postoperative clinical evaluation of shoulder level and posture should be included in the routine assessment of pectus patients to better understand and anticipate these segment-specific alignment changes.