Incidence and risk factors of postoperative medial shoulder imbalance in Lenke Type 2 adolescent idiopathic scoliosis with lateral shoulder balance

Abstract

Background In clinical practice, there are a significant percentage of Lenke 2 AIS patients suffered from medial shoulder imbalance (MSI) despite achieving good lateral shoulder balance (LSB) following surgery. However, there are few studies evaluating the features of the medial shoulder. The objective of this study was to determine the incidence and independent risk factors of MSI with LSB after Lenke 2 AIS corrective surgery. Methods One hundred and twenty Lenke 2 AIS patients with LSB at the last follow-up were reviewed from 2009 to 2018. Preoperative, and 3-month and the last postoperative follow-up radiographs were measured using a number of specific measurements. At the last follow-up, patients were divided into medial shoulder balance (MSB) group and the MSI group according to whether the T1 tilt was greater than 3°. A stepwise multiple linear regression analysis was used to examine the independent risk factors for MSI. Scoliosis Research Society (SRS)-30 questionnaire was used to assess clinical outcomes. Results Up to 69.2% of patients suffered from MSI with LSB after Lenke Type 2 AIS corrective surgery. Multiple regression showed that postoperative upper instrumented vertebra tilt (UIVt), proximal thoracic curve (PTC), the ratio of PTC and main thoracic curves (PTC/MTC) and T2 vertebra rotation ratio (T2-VR) were significant predictors for MSI (UIVt: b = 0.398, p < 0.001; PTC/MTC: b = 2.085, p < 0.001; PTC: b = 0.155, p < 0.001; T2-VR: b = 3.536, p = 0.008; adjusted R2 = 0.711). 72 patients completed the SRS-30 questionnaire survey, and the MSB group were scored the higher (p ≤ 0.001) in self-image domain (4.18 ± 0.43 vs. 3.70 ± 0.35), satisfaction domain (4.39 ± 0.54 vs. 3.95 ± 0.46) and total average (4.31 ± 0.23 vs. 4.11 ± 0.19). Conclusion Although the patients with Lenke 2 AIS achieve LSB after corrective surgery, up to 69.2% of them suffered from MSI. Postoperative UIVt, PTC, PTC/MTC and T2-VR were significant predictors for MSI. Sufficient correction of these variables may facilitate the achievement of MSB.

Can We Control Lateral Shoulder Balance Through Proximal Thoracic Curve Correction in Lenke Type 2 Adolescent Idiopathic Scoliosis?

“…Recent studies reported that postoperative medial shoulder balance and lateral shoulder balance were different in AIS patients with Lenke type 2 11,12 . Chung et al 11 demonstrated that medial and lateral shoulder discordance occurred by 46.4% in Lenke 1 and 2 AIS patients, and this was 67.5% in Lenke 2 curve.…”

“…This is caused by especially Lenke type 2; PTC is usually more rigid than MTC. 12,13,25 The inherent rigidity of the proximal thoracic spine, due to its anatomic characteristics such as short and relatively thick ribs that articulate with the sternum anteriorly, further restricts motion. This anatomic restriction underscores the significant impact proximal deformities and fusions can have on pulmonary functions.…”

“…Chung et al 11 demonstrated that medial and lateral shoulder discordance occurred by 46.4% in Lenke 1 and 2 AIS patients, and this was 67.5% in Lenke 2 curve. This is caused by especially Lenke type 2; PTC is usually more rigid than MTC 12,13,25 . The inherent rigidity of the proximal thoracic spine, due to its anatomic characteristics such as short and relatively thick ribs that articulate with the sternum anteriorly, further restricts motion.…”

“…11 Recent studies have demonstrated that it is caused by discordance of medial and lateral shoulder balance. [11][12][13] Kwan et al 14 described that radiologic parameters reflecting medial and lateral shoulder imbalance were distinct from one another. In addition, medial and lateral shoulder imbalance may not always be in same directionalities.…”

“…There have been reports showing that the incidence of PSI occur from 6.7% to 55.4% 11 . Recent studies have demonstrated that it is caused by discordance of medial and lateral shoulder balance 11–13 . Kwan et al 14 described that radiologic parameters reflecting medial and lateral shoulder imbalance were distinct from one another.…”