Efficiency of non-operative management for pectus deformities in children using an X-ray-free protocol

OBJECTIVES: The aim of this study was to explore the correlation between the Haller index (HI), the external depth of protrusion and the external Haller index (EHI) for both pectus excavatum (PE) and pectus carinatum (PC) and to assess the variation in the HI during this first year of non-operative treatment for pectus deformities in children. METHODS: From January 2018 to December 2022, all children treated for PE by vacuum bell and for PC by compression therapy at our institution were evaluated by external gauge, 3D scanning (iPad with Structure Sensor and Captevia—Rodin4D) and magnetic resonance imaging (MRI). The main objectives were to assess the effectiveness of the treatment during the first year and to compare the HI determined by MRI to the EHI evaluated with 3D scanning and external measurements. The HI determined by MRI was compared to the EHI evaluated with 3D scanning and external measurements at M0 and M12. RESULTS: A total of 118 patients (80 PE and 38 PC) had been referred for pectus deformity. Of these, 79 met the inclusion criteria (median age 13.7 years, 8.6–17.8). There was a statistically significant difference in the external measurements of the depth for PE between M0 and M12: 23.0 ± 7.2 vs 13.8 ± 6.1 mm, respectively, P < 0.05, and for PC 31.1 ± 10.6 vs 16.7 ± 8.9 mm, respectively, P < 0.01. During this first year of treatment, the reduction in the external measurement increased more rapidly for PE compared with PC. We found a strong correlation between the HI by MRI and the EHI by 3D scanning for PE (Pearson coefficient = 0.910, P < 0.001) and for PC (Pearson coefficient = 0.934, P < 0.001). A correlation between the EHI by 3D scanning and the external measurements by profile gauge was found for PE (Pearson coefficient = 0.663, P < 0.001) but not for PC. CONCLUSIONS: Excellent results were observed as soon as the sixth month for both PE and PC. Measurement of protrusion is a reliable monitoring tool at clinical consultation but caution is required for PC as it does not appear to be correlated to the HI by MRI.