How Is Mild Scoliosis Monitored in Patients Being Treated for Pectus Deformity?
- 2 days ago
- 6 min read
Pectus carinatum or pectus excavatum patients being followed for their chest wall condition may also show a mild curvature of the spine (scoliosis). This is not a rare coincidence in the literature; because the chest wall and the spine develop as part of the same growth process, this co-occurrence is described as an expected association [1] [2].
On our site, we've previously published an article covering the general relationship between pectus and scoliosis. This article focuses on a different question: in practice, how is the monitoring and follow-up process managed when both conditions occur together?
This article does not offer any patient-specific diagnosis, severity rating, or treatment recommendation; the information shared here is drawn from published scientific literature. An individualized assessment can only be made through a clinical examination.
Why Can Pectus Deformity and Scoliosis Occur Together?
The breastbone (sternum), rib cartilage, and spine develop as an interconnected skeletal system during growth. The literature reports that a deformity in the front chest wall can also lead to rotation of the thoracic vertebrae, meaning the two structures do not necessarily progress independently of each other during growth [3].
For this reason, reviewing the spine in a patient with a pectus deformity is a general approach recommended in the literature [1] [3]. This does not mean every pectus case will necessarily be accompanied by scoliosis; it simply reflects a finding that the two conditions may be related through the same growth mechanism.
How Often Do the Two Conditions Occur Together?
A systematic review combining 48 studies reported that the average prevalence of adolescent idiopathic scoliosis (AIS) in patients with a pectus deformity is approximately 13.1% [1].
A smaller imaging study, meanwhile, diagnosed AIS in 8 of 54 patients with pectus excavatum (about 14.8%), and showed that deformation of the front chest wall was associated with rotation of the thoracic vertebrae [3].
These figures do not mean that "every patient with a pectus deformity has scoliosis" — quite the opposite, most patients do not have accompanying scoliosis. However, the rate is too high to be explained by coincidence alone, which is why the literature recommends also observing the spine during pectus follow-up [1] [3].
Which Is Noticed First? The Timing Difference
According to the same systematic review, pectus deformity tends to be noticed earlier in adolescence than scoliosis; cases where both conditions were reported together were seen more often in older patients [1].
In practice, this timing difference can mean the following: a family may first notice and seek care for a change in the chest wall, while the spinal curvature may only become apparent later, as growth progresses. For this reason, rather than a one-time evaluation, monitoring both structures at regular intervals throughout the growth years is the recommended approach.
The Link Between Sternal Rotation and the Spine
In a study of patients with asymmetric chest wall deformity, a strong correlation was found between the rotation angle of the sternum and the degree of chest wall asymmetry (r=0.796) [4]. This shows that rotation of the front chest wall is not random but follows a measurable pattern.
The same study also reported that this rotation angle increases as growth progresses, particularly around ages 10-12 [4]. Given that rotation of the thoracic vertebrae may be linked to a similar growth dynamic, it can be said that the two structures may change together over time [3] [4].
Why Does It Matter to Monitor Both Conditions Together?
Pectus deformity and scoliosis are evaluated by different specialties — one focuses on the chest wall, the other on the spine. When both conditions occur together, it's important that these two evaluations are coordinated so that neither is overlooked while the other is being monitored.
For example, if spinal curvature goes unnoticed in a patient who comes in regularly for pectus follow-up, the progression of the scoliosis may not be tracked. Similarly, in a patient monitored only for scoliosis, changes in the chest wall could be missed.
The growth years are a critical period for both conditions. Since the literature shows that sternal rotation can change as growth accelerates [4], adjusting the frequency of follow-up to the patient's growth stage — for example, more frequent checks during rapid growth periods — is considered a reasonable approach in the literature.
Having both conditions together can be an added source of concern for families and adolescent patients; appearance-related worry may feel more pronounced when it affects two structures at once. At this point, it can help to discuss both the physical assessment and how the patient is experiencing this process with a specialist.
In fact, within Pectuslab, we have also developed a design that combines the Gpad pectus carinatum brace with the Yuxel Lomber Ortez in a single product, for patients who need both chest wall treatment and lower trunk/lumbar support. This shows that an integrated approach can be possible instead of using two separate devices; as with any design not currently matched elsewhere on the market, which patients it is suitable for can only be determined through a specialist assessment.
What Is Assessed During Follow-Up?
On the pectus side, the severity of the chest wall condition is generally assessed using the Haller index and asymmetry measurements [4]. On the spine side, the degree of scoliosis is expressed using the Cobb angle; these two measures are not interchangeable and are tracked separately.
Imaging methods (such as CT scans or X-rays) can be used to assess both structures, but which method is used and how often is determined by the clinician based on the patient's age, growth stage, and findings [1] [3].
The frequency of assessment is not defined by a single fixed number in the literature; instead, it is personalized by the clinician based on the patient's age, growth stage, and the severity of initial findings. For some patients, an annual check may be sufficient, while more frequent intervals may be recommended for cases showing rapid change.
As Pectuslab, we provide general information and referral support regarding chest wall deformities; in cases where pectus and scoliosis occur together, a direct consultation with a specialist is required for a definitive assessment — this may be a thoracic surgeon, pediatric surgeon, orthopedic specialist, or physical therapist; which specialty takes priority depends on the findings, and if necessary, an evaluation process involving more than one specialty may be followed.
Does Treating Pectus Affect Scoliosis, or Vice Versa?
A review on surgical pectus correction reported that pectus surgery performed at an older age was not associated with an increase in the postoperative Cobb angle, and that in a limited dataset of patients with a high Cobb angle, the Cobb angle did not increase after pectus correction [1] [2]. These findings relate specifically to surgical pectus correction.
For non-surgical approaches (such as vacuum bell devices or braces), there is no literature of comparable size on this topic; there is no claim that such products have an effect on spinal curvature, and this article makes no such claim either. How pectus treatment should be planned in a patient who also has scoliosis is determined separately by the clinicians evaluating both conditions.
We Have a Separate Resource for Spinal Care
Pectuslab works in the field of chest wall deformities (pectus carinatum, pectus excavatum, flared ribs). Because spinal curvatures (scoliosis, kyphosis) and lumbar support products require a different specialty and product line, we present our information and products in this area (including the Yuxel scoliosis brace) through a separate resource: [skolyozorteztedavisi.com](https://www.skolyozorteztedavisi.com). Detailed information about spinal curvature can be found there; this article does not make any product-specific claims (suitability, sizing, success rates).
When Should You See a Specialist?
If, during pectus follow-up, a noticeable curvature of the spine, a visible asymmetry in shoulder or hip alignment, or symptoms such as back pain are noticed, seeking a separate evaluation from a specialist is a reasonable next step — this may be a thoracic surgeon, pediatric surgeon, orthopedic specialist, or physical therapist, and which one takes priority depends on the findings.
Frequently Asked Questions
Why should someone being treated for pectus deformity also be checked for scoliosis?
The literature reports that adolescent idiopathic scoliosis occurs alongside pectus deformity in an average of about 13-15% of patients [1] [3]. This rate does not mean the two conditions are frequently confused with each other, but it is significant enough to justify also considering the spine during pectus follow-up.
Can pectus treatment (vacuum bell/brace) be used in a patient who has scoliosis?
This is a matter to be assessed by the clinician based on the patient's findings and the degree of scoliosis; no claim of suitability is made within this article. In cases where both conditions occur together, the treatment plan is determined through a joint assessment by the relevant specialists.
Closing
The co-occurrence of pectus deformity and mild scoliosis is an expected and relatively frequently reported finding in the literature. What matters is that these two structures are monitored separately but in a coordinated way, and assessed at regular intervals throughout the growth years. A definitive diagnosis, follow-up frequency, and treatment plan are always determined through a specialist examination.
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