Evidence basis for management of spine and chest wall deformities in children

STUDY DESIGN. Review of relevant studies, including levels of evidence. OBJECTIVE. To review research on growth of the spine and chest wall and treatment of deformities. To place this knowledge in context of evidence-based assessment. SUMMARY OF BACKGROUND DATA. Knowledge of the growth of the spine, chest wall, and lung in the normal and deformity states has evolved among independent specialties over the past 60 years. Interest in the interrelationship has blossomed as more tools for assessment and treatment have developed. Spine-based and chest wall-based treatment options now exist, as well as options of resection versus gradual distraction. METHODS. Peer-reviewed research published on the growth of the spine, lung, chest wall, and treatment of their deformities was reviewed. Treatment methods and outcomes were compared. Ranking of the levels of evidence was performed where possible. RESULTS. Most studies of these topics are Level III and IV studies, consisting of case-control studies and case series. This limitation arises because of the rarity and heterogeneity of the disorders affecting the growing spine and chest wall. The natural history of most types of spinal/chest wall deformities is not known with accuracy. Some experimental evidence informs the treatments which involve modulation of the growth of the spine. However, accurate models of the deformities themselves are lacking. Improvements in imaging and measurement offer options for more accurate patient comparison. CONCLUSION. The natural history and results of treatment of deformities of the spine and chest wall offer much opportunity for further evidence-based research.