Scoliosis in children with anterior chest wall deformities

An association between anterior chest wall deformities and scoliosis is described in the literature but is poorly defined. It appears that only approximately 4% to 5% of patients with severe anterior chest wall deformities have scoliosis of sufficient magnitude to warrant evaluation and observation by a spinal deformity physician. The relationship between anterior chest wall deformity and scoliosis is most clear in patients with Marfan syndrome. Marfan patients with scoliosis are at high risk for progression of deformity to unacceptable levels and have historically not responded well to brace therapy. The causes of anterior chest wall deformity and scoliosis remain unclear, although unbalanced cartilage growth has been proposed as a potential cause of both. Some have proposed that chest wall deformity may result in asymmetric spinal forces and subsequent scoliosis secondary to altered spinal growth. Because of the association between pectus deformities and scoliosis, patients with anterior chest wall deformities should be carefully examined for signs of scoliosis and have screening radiographs if indicated. Young patients in particular should be referred to a spinal deformity physician, because it is clear that patients who present with spinal deformity prior to age 5 years are the ones at risk for adverse cardiopulmonary sequelae related to spinal deformity. Most children with scoliosis and anterior chest wall deformities need only observation of the scoliosis. In more severe cases, the management of spinal deformity traditionally involves the use of bracing to attempt to control curves of lesser magnitude and surgical management for unacceptable deformities or curves of magnitudes too great for brace treatment. There are no studies that specifically address the use of these methods in patients with both anterior chest wall deformities and scoliosis. The management of scoliosis in patients with anterior chest wall deformities follows treatment principles outlined for idiopathic scoliosis patients.