The amount of surgical correction of the main thoracic curve is the best predictor of postoperative clinical shoulder balance in patients with Adolescent Idiopathic Scoliosis

Hiett, Andy; Tung, Robert; Emanuelli, Elisa; Sherman, Ashley; Anderson, John T.; Schwend, Richard M.

doi:10.1007/s43390-020-00147-9

Cited by 6 publications

(7 citation statements)

References 18 publications

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“…Many techniques for preventing LSI have been reported, such as appropriate correction rate of the MT curve [ 1 , 21 , 22 ] and selection of an appropriate UIV [ 9 , 13 , 14 , 23 ]; however, this complication remains prevalent in scoliosis patients, reported in at least 25% of cases [ 1 , 2 ], and how to achieve LSB postoperatively remains unclear [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

A Novel Method for Predicting Ideal Postoperative Upper Instrumented Vertebra Tilt to Prevent Lateral Shoulder Imbalance after Scoliosis Correction Surgery

Zhang

et al. 2023

JPM

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Lateral shoulder imbalance (LSI) is reflected radiologically by the clavicle angle (CA). How to achieve postoperative lateral shoulder balance (LSB) after scoliosis correction surgery remains unclear. In the current study, by using the preoperative upper instrumented vertebra (UIV) tilt, the CA, the flexibility between T1 and the UIV, and the ideal postoperative UIV tilt was predicted based on the following formula: ideal postoperative UIV tilt = preoperative UIV tilt—the flexibility between T1 and UIV—preoperative CA. The reliability of the formula was verified through a retrospective analysis, and 76 scoliosis patients were enrolled. The feasibility of this method was verified through a prospective analysis, and 13 scoliosis patients were enrolled. In the retrospective study, there was a significant correlation between the difference in the actual and ideal postoperative UIV tilt values and the postoperative CA, with correlation coefficients in the whole, LSI, and LSB groups of 0.981, 0.982, and 0.953, respectively (p < 0.001). In the prospective study, all patients achieved satisfactory LSB. Using the formula preoperatively to predict an ideal postoperative UIV tilt and controlling the intraoperative UIV tilt with the improved crossbar technique may be an effective digital method for achieving postoperative LSB and has important clinical significance.

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Section: Discussionmentioning

confidence: 99%

A Novel Method for Predicting Ideal Postoperative Upper Instrumented Vertebra Tilt to Prevent Lateral Shoulder Imbalance after Scoliosis Correction Surgery

Zhang

et al. 2023

JPM

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“…However, Jaysson et al found that choosing T4 as UIV was more effective to avoid PSI than either T2 or T3, regardless of which shoulder was raised preoperatively ( 23 ). Recently, several studies reported that PSI is not affected by UIV levels ( 10 , 24 ). The findings of these articles were consistent with our results that UIV did not affect the incidence of PSI.…”

Section: Discussionmentioning

confidence: 99%

“…Previous investigation found that a proximal UIV can avoid the occurrence of PSI ( 9 ). However, recent studies have indicated that PSI is not affected by the UIV level ( 10 , 11 ). Andy et al reported that a higher preoperative Cobb angle and increased surgical correction lead to an increased risk of PSI ( 10 ).…”

Section: Introductionmentioning

confidence: 97%

“…However, recent studies have indicated that PSI is not affected by the UIV level ( 10 , 11 ). Andy et al reported that a higher preoperative Cobb angle and increased surgical correction lead to an increased risk of PSI ( 10 ). In a retrospective review of 145 patients with AIS, John et al indicated that overcorrection of the main thoracic (MT) curve (>54%) with less correction (<52%) of the proximal thoracic (PT) curve lead to a higher incidence of PSI, regardless of the UIV( 11 ).…”

Section: Introductionmentioning

confidence: 97%

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Evaluation of the Radiographic Risk Factors of Postoperative Shoulder Imbalance in Adult Scoliosis

Wang

Hua

et al. 2022

Front. Surg.

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ObjectiveThis study aimed to evaluate the radiographic risk factors of postoperative shoulder imbalance (PSI) after adult scoliosis (AS) correction surgery.MethodsSeventy-nine patients with AS undergoing correction surgery at a single institution were reviewed. The mean follow-up was 28 months. Patients were divided into two groups based on their radiographic shoulder height (RSH): (1) the balanced group (RSH <10 mm) and (2) the unbalanced group (RSH ≥10 mm). The preoperative and postoperative Cobb angles of the proximal thoracic (PT), main thoracic (MT), thoracolumbar/lumbar (TL/L) and upper instrumented vertebra (UIV) were measured.ResultsNo significant difference was found between the balanced and unbalanced groups when the UIV was T1–2, T3–4, or below T4. Univariate analysis indicated that the unbalanced group had significantly higher postoperative RSH, lower percentage PT correction, and greater percentage MT correction. The classification and regression tree analysis revealed that when the correction percentage of PT curve was more than 55.3%, 84.4% of patients acquired shoulder balance. However, when the correction percentage of PT curve was less than 55.3%, and the correction percentage of MT curve was more than 56%, 65.7% of the patients developed PSI.ConclusionsIn AS correction surgery, a lower percentage correction of the PT curve and greater percentage correction of the MT curve were independent radiographic risk factors of PSI, regardless of the UIV level. Sufficient PT correction is required to achieve postoperative shoulder balance in AS correction surgery when the MT curve is overcorrected.

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“…However, most recently, several studies had reported that the selection of UIV did not affect postoperative shoulder height in AIS patients. Hiett reported that the amount of MT curve correction was the only significant factor associated with postoperative shoulder balance in AIS patients [ 11 ]. Moorthy insisted that both greater percentage of MT curve correction and lower postoperative MT curve were independent risk factors for PSI while the UIV selection was not [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Postoperative shoulder balance in Lenke type 1 adolescent idiopathic scoliosis patients with large thoracic curve (Cobb angle ≥ 70 degrees): a radiographic study

Jiang

Chen

Qiu

et al. 2022

BMC Musculoskelet Disord

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Background Large amounts of thoracic curve correction had been considered as a risk factor for postoperative shoulder imbalance (PSI) in adolescent idiopathic scoliosis (AIS) patients. This study aims to evaluate postoperative shoulder balance in Lenke type 1 AIS patients with large thoracic curve (Cobb angle ≥ 70 degrees) and compared it with those with moderate thoracic curve (Cobb angle < 70 degrees). Methods A total of 47 Lenke type 1 AIS patients underwent posterior correction surgery between Sept. 2016 to Nov. 2018 in our institution were included. All these patient were divided into 2 groups based on the severity of main thoracic (MT) curve. Group A consisted of 25 cases with MT curve equal to or more than 70 degree while Group B consisted of 22 cases with MT curve less than 70 degree. Proximal thoracic (PT) Cobb angle, MT Cobb angle, MT apical vertebral translation (AVT), T2-T5 kyphosis, T5-T12 kyphosis, and radiographic shoulder height (RSH) were compared between these 2 groups preoperatively, immediately after surgery, and at a minimum of two-year follow-up. Results Although all the correction of PT Cobb angle (15.8° ± 6.0° vs 12.5° ± 3.6°, P = 0.028), that of MT Cobb angle 47.3° ± 9.1° vs 30.9° ± 6.7°, P < 0.001) and that of MT AVT (35.1 mm ± 16.0 mm vs 24.1 mm ± 8.9 mm, P = 0.007) were significantly larger in Group A when compared with Group B, RSH was comparable between these 2 groups at last follow up (7.5 mm ± 7.4 mm vs 9.2 mm ± 4.2 mm P = 0.363). Most of the patients gained satisfactory shoulder balance with only 7 cases with minimal PSI in group A (28%) and only 6 cases with minimal PSI in group B (27.3%) at last follow-up (P > 0.05). Conclusions Although Lenke type 1 AIS patients with large thoracic curve had more amounts of MT curve correction when compared with those with moderate thoracic curve, it did not lead to higher incidence of PSI if the correction rate is proper.

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The amount of surgical correction of the main thoracic curve is the best predictor of postoperative clinical shoulder balance in patients with Adolescent Idiopathic Scoliosis

Cited by 6 publications

References 18 publications

A Novel Method for Predicting Ideal Postoperative Upper Instrumented Vertebra Tilt to Prevent Lateral Shoulder Imbalance after Scoliosis Correction Surgery

A Novel Method for Predicting Ideal Postoperative Upper Instrumented Vertebra Tilt to Prevent Lateral Shoulder Imbalance after Scoliosis Correction Surgery

Evaluation of the Radiographic Risk Factors of Postoperative Shoulder Imbalance in Adult Scoliosis

Postoperative shoulder balance in Lenke type 1 adolescent idiopathic scoliosis patients with large thoracic curve (Cobb angle ≥ 70 degrees): a radiographic study

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