Patients’ Perception and Satisfaction on Neck and Shoulder Imbalance in Adolescent Idiopathic Scoliosis

Lee, Sin Ying; Ch’ng, Pei Ying; Wong, Tat Seng; Ling, Xiu Wen; Chung, Weng Hong; Chiu, Chee Kidd; Chan, Chris Yin Wei; Lean, Mei Li; Kwan, Mun Keong

doi:10.1177/21925682211007795

Cited by 10 publications

(4 citation statements)

References 34 publications

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“…A stepwise multiple regression analysis showed that postoperative UIVt, PTC, PTC/MTC and T2-VR were risk factors for MSI. The results of the SRS-30 questionnaire were similar with those of earlier research [10], and the MSI group were dissatisfied with their appearances. The results of this study provide a wake-up call to surgeons to consider the common occurrence of MSI, and surgeons should make adequate preoperative planning to reduce the occurrence of this phenomenon.…”

Section: Discussionsupporting

confidence: 84%

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

Deng

Wang

et al. 2022

BMC Musculoskelet Disord

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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.

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Section: Discussionsupporting

confidence: 84%

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

Deng

Wang

et al. 2022

BMC Musculoskelet Disord

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“…Shoulder imbalance can be classified into two different types: medial shoulder imbalance (MSI) and lateral shoulder imbalance (LSI) ( 6 ). Current studies have shown that patients with AIS after spinal scoliosis correction surgery attach more importance to LSI because LSI has a greater impact on appearance compared to MSI ( 23 ). MSI is reflected radiologically by the T1 tilt angle (the angle between the horizontal line and the line passing through the endplate of T1), the first rib angle (FRA, the angle of inclination between the tangents that connect the two tops of the first rib), and the degree of curvature at the proximal thoracic (PT) region ( 7 , 8 ).…”

Section: Discussionmentioning

confidence: 99%

Correlation analysis and clinical significance of changes in upper thoracic vertebra tilt and clavicle angle pre- and post-operation

Jiang,

Wang,

Cui

et al. 2024

Front. Surg.

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The imbalance of the lateral shoulder is reflected by the clavicle angle (CA) in radiology. It remains unclear how to achieve postoperative lateral shoulder balance (LSB) after spinal deformity correction surgery. A retrospective analysis was conducted on AIS patients who underwent surgery by the same spine surgeon at our hospital from 2016 to 2020. A total of 110 patients with spinal deformity were included in the study to verify the correlation between the T1–T5 tilt angle and CA before and after surgery, as well as the relation-ship between the change in T1–T5 tilt angle before and after surgery and the change in CA before and after surgery. By comparing the correlation coefficients, it was found that there may not be a direct relationship between the pre- and postoperative tilt angles of T1–5 and CA, but their changes were closely related to the changes in CA. The change in T1 tilt angle after orthopaedic surgery was significantly correlated with the change in CA, with a correlation coefficient of 0.976, indicating a close relationship between T1 and the clavicle. As the vertebrae moved down, the correlation gradually decreased. In summary, this study suggests that there is a close relationship between T1–T5 and the clavicle and that the change in T1 tilt angle after spinal scoliosis correction surgery is significantly correlated with CA, which decreases as the vertebra moves down.

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“…This study is the first to suggest that functional disabilities due to upper extremity skeletal muscle asymmetry in the elderly are a new target for AIS treatment. A recent study revealed that shoulder imbalance in AIS patients had a very large impact on their satisfaction with appearance [ 16 ]. Because postoperative shoulder imbalance (PSI) commonly causes dissatisfaction among AIS patients, numerous reports have focused on techniques and fixation ranges to reduce PSI [ 17 , 18 , 19 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

Upper Extremity Skeletal Muscle Mass Asymmetry Exacerbated by Shoulder Imbalance in Lenke1A Adolescent Idiopathic Scoliosis

Ohba

Goto

Tanaka

et al. 2022

JCM

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Limb muscle strength asymmetry affects many physical abilities. The present study (1) quantified limb muscle asymmetry in patients with adolescent idiopathic scoliosis (AIS); (2) compared AIS patients with major thoracolumbar/lumbar (TL/L) or major thoracic (MT) curves; (3) examined correlations between limb muscle asymmetry and radiographic parameters. Patients with AIS with major TL/L curves (Lenke type 5C) and MT curves (Lenke Type 1A) who underwent posterior spinal fusion at our university hospitals were included. Patients with left hand dominance were excluded. Body composition was measured using whole-body dual-energy X-ray absorptiometry and asymmetry of left and right side skeletal muscles were evaluated. Upper extremity skeletal muscles on the dominant side were significantly larger than those on the nondominant side in both Lenke1A and 5C groups. The asymmetry of upper extremity skeletal muscles was significantly greater in the Lenke1A group than in the Lenke5C group. Additionally, the size of the asymmetry did not correlate with the magnitude of the major curve and rotational deformation but did correlate with a right shoulder imbalance in the Lenke1A group. These results suggest that in AIS with a constructive thoracic curve, right shoulder imbalance is an independent risk factor for upper extremity skeletal muscle asymmetry.

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Patients’ Perception and Satisfaction on Neck and Shoulder Imbalance in Adolescent Idiopathic Scoliosis

Cited by 10 publications

References 34 publications

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

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

Correlation analysis and clinical significance of changes in upper thoracic vertebra tilt and clavicle angle pre- and post-operation

Upper Extremity Skeletal Muscle Mass Asymmetry Exacerbated by Shoulder Imbalance in Lenke1A Adolescent Idiopathic Scoliosis

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