{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T11:13:15Z","timestamp":1788174795888,"version":"build-2803163510"},"reference-count":27,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2020,10,30]],"date-time":"2020-10-30T00:00:00Z","timestamp":1604016000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,1,29]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p\/><jats:sec><jats:title>OBJECTIVES<\/jats:title><jats:p>The Nuss technique comprises the placement of an intrathoracic bar behind the sternum. However, besides improving the body posture through the correction of the pectus excavatum (PE), this procedure may cause or worsen thoracic scoliosis as a result of the considerable stress loaded on the chest wall and the thorax. Our goal was to investigate the impact of the Nuss procedure on the thoracic spinal curvature in patients with PE.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>A total of 100 patients with PE who underwent the Nuss procedure were included in the study and evaluated retrospectively. The Haller index (HI), asymmetry index and sternal torsion angle were calculated from thoracic computed tomography images before the operation. To evaluate the scoliosis in the T2\u2013T8 thoracic vertebrae, Cobb angles were calculated on a plain chest X-ray before the Nuss operation and after the removal of the bar. Cobb angles were classified as normal (5\u00b0), scoliotic posture (5\u00b0\u201310\u00b0) and scoliosis (&amp;gt;10\u00b0). All angles before and after the Nuss operation were compared. The patients were followed up for a mean of 41\u2009months. Substernal bars were removed after a mean of 33\u2009months.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>The mean age of the patients was 19.6\u2009\u00b1\u20096.7\u2009years. The Cobb angle was statistically significantly increased in all patients (P\u2009=\u20090.01), male patients (P\u2009=\u20090.01) and children (P\u2009=\u20090.046) but not in adults (P\u2009=\u20090.11) and female patients (P\u2009=\u20090.54). The Cobb angle was increased in patients with severe (HI \u2265 3.5) but not in patients with moderate (3.2 &amp;lt; HI\u2009&amp;lt;\u20093.5) or mild (2.0 &amp;lt; HI\u2009&amp;lt;\u20093.2) PE deformity.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>The present study shows that the Cobb angle indicates that the severity of thoracic scoliosis increases following the Nuss procedure, particularly in male patients, in patients with mild and moderate sternal torsion angle and in those with a high preoperative HI. This alteration might be due to correctional forces and torque applied by the bar. Patients undergoing the Nuss procedure for the correction of PE should be followed up strictly for timely diagnosis and management of the scoliosis.<\/jats:p><\/jats:sec>","DOI":"10.1093\/ejcts\/ezaa328","type":"journal-article","created":{"date-parts":[[2020,8,13]],"date-time":"2020-08-13T19:25:10Z","timestamp":1597346710000},"page":"375-381","source":"Crossref","is-referenced-by-count":4,"title":["The effect of minimally invasive pectus excavatum repair on thoracic scoliosis"],"prefix":"10.1093","volume":"59","author":[{"given":"Mehlika","family":"\u0130\u015fcan","sequence":"first","affiliation":[{"name":"Department of Thoracic Surgery, Gebze Fatih State Hospital, Kocaeli, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Burcu","family":"K\u0131l\u0131\u00e7","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Istanbul University-Cerrahpa\u015fa, Cerrahpa\u015fa School of Medicine, Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3229-830X","authenticated-orcid":false,"given":"Akif","family":"Turna","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Istanbul University-Cerrahpa\u015fa, Cerrahpa\u015fa School of Medicine, Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4020-7554","authenticated-orcid":false,"given":"Mehmet Kamil","family":"Kaynak","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Istanbul University-Cerrahpa\u015fa, Cerrahpa\u015fa School of Medicine, Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,10,30]]},"reference":[{"key":"2021020107564198300_ezaa328-B1","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1053\/j.semtcvs.2009.03.001","article-title":"Anatomical, histologic, and genetic characteristics of congenital chest wall deformities","volume":"21","author":"Fokin","year":"2009","journal-title":"Semin Thorac Cardiovasc Surg"},{"key":"2021020107564198300_ezaa328-B2","doi-asserted-by":"crossref","first-page":"e403","DOI":"10.3928\/19382359-20161007-01","article-title":"Pectus excavatum: more than a matter of aesthetics","volume":"45","author":"Abdullah","year":"2016","journal-title":"Pediatr Ann"},{"key":"2021020107564198300_ezaa328-B3","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1093\/icvts\/ivs045","article-title":"Pectus excavatum: history, hypotheses and treatment options","volume":"14","author":"Brochhausen","year":"2012","journal-title":"Interact CardioVasc Thorac Surg"},{"key":"2021020107564198300_ezaa328-B4","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1186\/1471-2296-12-49","article-title":"Is it feasible and effective to provide osteopathy and acupuncture for patients with musculoskeletal problems in a GP setting? 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