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Background <p>Pectus excavatum (PE) and pectus carinatum (PC), structurally opposite chest wall deformities, provides a unique opportunity to investigate the relationship between chest deformities and thoracic scoliosis.</p> Methods <p>The study collected 2014 to 2024 medical records and radiological data. Cross-sectional analysis included 1315 PE/PC patients and 5140 matched controls; retrospective cohort analysis included 549 patients. Radiographic measurements assessed Haller index indicating chest deformity severity, recorded thoracic asymmetry, and utilized Cobb angle to evaluate scoliosis severity. Logistic regression and Cox models evaluated associations.</p> Results <p>Cross-sectionally, PE/PC patients showed higher scoliosis prevalence (9.86% vs. 4.67%, <i>P</i> &lt; 0.001) and severity. PE and PC conferred 2.389-fold ( <i>P</i> &lt; 0.01) and 1.673-fold (<i>P</i> = 0.007) increased scoliosis risk, respectively. In the retrospective cohort study, PE/PC patients had higher de novo scoliosis incidence (12.7% vs. 5.1%), with Haller index &gt; 3.25 increasing risk (HR = 2.464, <i>P</i> = 0.003). the Nuss procedure reduced new-onset scoliosis in PE (10-20y: HR = 0.544, <i>P</i> = 0.107) but increased progression in pre-existing PE scoliosis (HR = 5.94). Conversely, reverse Nuss surgery significantly increased new-onset scoliosis in PC (HR = 9.087, <i>P</i> &lt; 0.001).</p> Conclusion <p>PE/PC substantially elevate scoliosis incidence and severity. Haller index &gt; 3.25 independently escalates risk. Crucially, surgical interventions demonstrate divergent effects. Nuss surgery may protect against new-onset scoliosis in PE but risks exacerbating progression in established cases, while reverse Nuss surgery significantly increases new-onset scoliosis in PC patients.</p>

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The Nuss and reverse Nuss procedure paradox: divergent outcomes in scoliosis risk for pectus excavatum and pectus carinatum patients

  • 期刊论文

  • 发表日期：

    2025年8月25日

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  • Shuhao Zhang,
  • Yuriu Wu,
  • Shuqing Jin,
  • Yuli Chen,
  • Chanqiong Zhang,
  • Majid Nisar,
  • Xiangxiang Pan,
  • Ruolan Liu,
  • Wenjing Jin,
  • Fengyu Zhang,
  • Aimin Wu,
  • Xiangyang Wang,
  • Chongan Huang

摘要

Background

Pectus excavatum (PE) and pectus carinatum (PC), structurally opposite chest wall deformities, provides a unique opportunity to investigate the relationship between chest deformities and thoracic scoliosis.

Methods

The study collected 2014 to 2024 medical records and radiological data. Cross-sectional analysis included 1315 PE/PC patients and 5140 matched controls; retrospective cohort analysis included 549 patients. Radiographic measurements assessed Haller index indicating chest deformity severity, recorded thoracic asymmetry, and utilized Cobb angle to evaluate scoliosis severity. Logistic regression and Cox models evaluated associations.

Results

Cross-sectionally, PE/PC patients showed higher scoliosis prevalence (9.86% vs. 4.67%, P < 0.001) and severity. PE and PC conferred 2.389-fold ( P < 0.01) and 1.673-fold (P = 0.007) increased scoliosis risk, respectively. In the retrospective cohort study, PE/PC patients had higher de novo scoliosis incidence (12.7% vs. 5.1%), with Haller index > 3.25 increasing risk (HR = 2.464, P = 0.003). the Nuss procedure reduced new-onset scoliosis in PE (10-20y: HR = 0.544, P = 0.107) but increased progression in pre-existing PE scoliosis (HR = 5.94). Conversely, reverse Nuss surgery significantly increased new-onset scoliosis in PC (HR = 9.087, P < 0.001).

Conclusion

PE/PC substantially elevate scoliosis incidence and severity. Haller index > 3.25 independently escalates risk. Crucially, surgical interventions demonstrate divergent effects. Nuss surgery may protect against new-onset scoliosis in PE but risks exacerbating progression in established cases, while reverse Nuss surgery significantly increases new-onset scoliosis in PC patients.