Treatment
The most common treatment for pectus carinatum is the use of a compressive brace during times of growth. This brace wraps around the chest and applies a light, gradual pressure over the projected area to reshape the chest wall while the patient is growing. This can be custom-made or off-the-shelf, depending on the child’s body shape and location of the projected area. The amount of correction achieved directly relates to the amount of time the child wears the brace. Ideally, they will wear the brace 16 to 23 hours a day through their adolescent growth spurt. As the chest wall reshapes and the patient grows, follow-up appointments will be necessary to make sure the brace continues to fit and function correctly.
Research has shown that patients who wear their brace for the prescribed amount of time have significant improvement in appearance and long-term correction, eliminating the need for surgical intervention. If left untreated, pectus carinatum can progress, becoming more noticeable and permanent as a person reaches skeletal maturity. Once a patient has finished growing and has reached skeletal maturity, an orthotic brace is no longer an effective treatment and surgical intervention may be an option.
Jung, Joonho et al. “Brace compression for treatment of pectus carinatum.” The Korean journal of thoracic and cardiovascular surgery vol. 45,6 (2012): 396-400. doi:10.5090/kjtcs.2012.45.6.396 | Lee, Richy T et al. “Bracing is an effective therapy for pectus carinatum: interim results.” Journal of pediatric surgery vol. 48,1 (2013): 184-90. doi:10.1016/j.jpedsurg.2012.10.037 | Moon, Duk Hwan et al. “Long-Term Results of Compressive Brace Therapy for Pectus Carinatum.” The Thoracic and cardiovascular surgeon vol. 67,1 (2019): 67-72. doi:10.1055/s-0038-1669927
Diagnosis
The diagnosis may be confirmed through a physical assessment by an orthopedist, neurosurgeon, or neurologist. Typically, a radiograph is taken to confirm the alignment of the spine and the magnitude of the curve. X-rays are usually taken at regular intervals to confirm any changes in the scoliotic curves and to confirm if the curves are responding to brace treatment.
Treatment
Early intervention is important. Neuromuscular scoliosis is much more likely to produce curves that progress, and continue progressing into adulthood. As the scoliosis curve magnitude increases, the patient may develop progressive loss of balance and later have difficulty with mobility and walking. If left untreated, the curve may become less flexible, causing seating issues, hygiene issues, and possibly leading to thoracic insufficiency syndrome and interfering with lung function.
A spinal orthosis or custom thoracic lumbar sacral orthosis (TLSO) can be prescribed as a means to improve spinal alignment. The main goal of this orthosis is to provide stability, alignment of the spine, and sitting balance to encourage independence of the patient’s arms and hands. With the custom TLSO, enhancements and customizations can be made to accommodate for other indications based on the patient’s condition. For patients in a wheelchair, the brace can be worn to assist with transferring from a wheelchair to the bed and to improve head and neck alignment. The brace does not correct and may not prevent the progression of spinal curvature in a patient with neuromuscular scoliosis. The goal is to improve spinal alignment and increase the patient’s function.
Because children with neuromuscular scoliosis can have a range of medical issues in addition to the spinal curve, treatment involves a team of doctors and healthcare professionals from different medical specialties working together to provide care.
Neuromuscular Scoliosis. Scoliosis Research Society.
