Comparative characteristics of vertical body balance in children with different body types and pectus excavatum before and after surgery

BACKGROUND: To achieve a comprehensive understanding of the multilevel mechanisms underlying organ and system function in children with pectus excavatum, thoracic biomechanics and whole-body biomechanics have been increasingly studied. This enables clinicians to gain a clearer understanding of the full diversity of adaptive responses of the patient’s body to deformity surgery.

AIM: This study aimed to evaluate changes in postural responses in children with asymmetric pectus excavatum during different stages of postoperative rehabilitation, depending on body mass index.

METHODS: Two groups of patients of both sexes aged 13–16 years with severe left-sided pectus excavatum underwent clinical, radiological, and stabilometric assessments. The first group consisted of 18 patients with an asthenic body type and a body mass index below 18.50 kg/m². The second group comprised 15 normosthenic patients with a body mass index greater than 18.50 kg/m² and less than 24.99 kg/m². The exclusion criteria were as follows: overweight children; patients with right-sided or symmetric pectus excavatum; and those with other concomitant chest and thoracolumbar deformities and anomalies. All patients underwent minimally invasive reconstructive surgery to correct anterior chest wall deformity. The parameters of the whole-body center of pressure displacement and contralateral foot pressure centers were analyzed preoperatively and postoperatively (mean follow-up, 2 years). The results were compared with data from 20 healthy age-matched children with normal body mass index.

RESULTS: Preoperative stabilometric parameters indicated impaired vertical balance in both groups, with more pronounced disturbances in patients with asthenia. In all patients, compression of the pericardium by the deformed sternum was assumed to alter the characteristics of neural signals originating from its proprioceptors, thereby inducing changes in the postural control system. In addition, differences in postural strategies were identified between the patient groups, which presumably affected the stability of their vertical balance. After corrective surgery, normosthenic patients demonstrated greater improvement in vertical body balance compared with patients with asthenia. The achieved balance function was 83% and 78%, respectively (p = 0.047), which may be explained by variability in the adaptive capacity of the postural control system in patients with different body mass indexes. Following relief of pericardial compression, changes in the spectrum of proprioceptive signals in normosthenic patients may have led to more adequate postural system responses compared with asthenic patients.

CONCLUSION: Patients with pectus excavatum and low body mass index require a personalized rehabilitation strategy after minimally invasive surgery for deformity correction. This approach is intended to facilitate postoperative recovery in children and promote normalization of their postural balance.