Fulcrum flexibility of the main curve predicts postoperative shoulder imbalance in selective thoracic fusion of adolescent idiopathic scoliosis

2018 ◽  
Vol 27 (9) ◽  
pp. 2251-2261 ◽  
Author(s):  
Soren Ohrt-Nissen ◽  
Vijay H. D. Kamath ◽  
Dino Samartzis ◽  
Keith Dip Kei Luk ◽  
Jason Pui Yin Cheung
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Selective Thoracic Fusion ◽  
Postoperative Shoulder Imbalance ◽  
Shoulder Imbalance ◽  
Postoperative Shoulder ◽  
Main Curve

Analysis of Preoperative and Operative Factors Influencing Postoperative Shoulder Imbalance in Lenke Type 1 Adolescent Idiopathic Scoliosis

2021 ◽  
Author(s):  
Clara Berlin ◽  
Markus Quante ◽  
Esther Freifrau von Richthofen ◽  
Henry Halm
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Lumbar Curve ◽  
Curve Correction ◽  
Postoperative Shoulder Imbalance ◽  
Shoulder Imbalance ◽  
Shoulder Position ◽  
Postoperative Shoulder ◽  
Shoulder Elevation

Abstract Background Postoperative shoulder imbalance is a common complication in adolescent idiopathic scoliosis and may impair patient satisfaction. The little data in the literature on the prediction and treatment of postoperative shoulder imbalance is incongruous. According to some studies, postoperative shoulder imbalance depends on the superior instrumented vertebral bodies, skeletal maturity, extent of correction and flexibility of the major curve. Question Can preoperative radiological parameters from X-ray and traction films as well as correction of the curves be used to identify a factor impacting on postoperative shoulder imbalance? Material and Methods Prospective data in adolescent idiopathic scoliosis with thoracic curve (Lenke type 1), operated on between 2015 and 2018 at a scoliosis centre, were analysed retrospectively based on full-length X-rays of the spine (pre-/postOP and follow-up (FU)) and preoperative-traction films: age; correction of proximal, main and lumbar curve; shoulder height [mm]; clavicle angle [°]; T1 tilt [°]; coronal plumb line deviation [mm]. The findings were expressed as means with standard deviation. Changes in parameters over time (postOP-FU) were compared by t test (significance level α = 0.05). The correlation between preOP parameters and extent of correction with postoperative shoulder imbalance (≥ 15 mm) was determined by Pearson correlation and regression classification analysis. Outcomes 55 patients with adolescent idiopathic scoliosis, mean age of 15 ± 1.4 years. The FU-rate after a mean of 15 months was 80% (n = 44). Correction of proximal, main and lumbar curve: 47.0%, 75.8% and 68.8%, respectively, without statistically significant change (Δ) in FU (p > 0.05). Shoulder height was − 11.0 ± 12.7 mm (preOP), 15.5 ± 13.4 mm (postOP), 10.1 ± 10.6 mm (FU) (p < 0.05). 38% of those with adolescent idiopathic scoliosis had preOP right shoulder elevation; 55% (postOP) and 32% (FU) respectively had postoperative shoulder imbalance (left shoulder elevation). Strong statistical correlation was found for Δshoulder position (FU-preOP) with pre-OP shoulder position (r = − 0.7), and Δshoulder position (pre-OP traction films) (r = 0.5) with pre-OP clavicle angle (r = − 0.5). On regression classification analysis, 81.8% of cases did display postoperative shoulder imbalance if proximal curve correction was ≤ 64.4%; main and lumbar curve correction, Δshoulder elevation (preOP traction films) played a secondary role. Discussion One common complication even in Lenke type 1 adolescent idiopathic scoliosis is postoperative shoulder imbalance. Preoperative planning should include traction films, preoperative shoulder position and clavicle angle to avoid postoperative shoulder imbalance. Moderate correction of proximal curve is critical for postoperative shoulder balance.

Risk Factors of Postoperative Shoulder Imbalance in Adolescent Idiopathic Scoliosis

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Vikaesh Moorthy ◽  
Graham S. Goh ◽  
Chang-Ming Guo ◽  
Seang-Beng Tan ◽  
John Li-Tat Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Postoperative Shoulder Imbalance ◽  
Shoulder Imbalance ◽  
Postoperative Shoulder

Surgical Predictors for Prevention of Postoperative Shoulder Imbalance in Lenke Type 2A Adolescent Idiopathic Scoliosis

Spine ◽  
2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Tatsuya Sato ◽  
Ikuho Yonezawa ◽  
Hiroko Matsumoto ◽  
Nao Otomo ◽  
Teppei Suzuki ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Postoperative Shoulder Imbalance ◽  
Shoulder Imbalance ◽  
Postoperative Shoulder

Postoperative shoulder imbalance in adolescent idiopathic scoliosis: risk factors and predictive index

2019 ◽  
Vol 28 (6) ◽  
pp. 1331-1341 ◽  
Author(s):  
Yilin Yang ◽  
Mingyuan Yang ◽  
Jian Zhao ◽  
Yinchuan Zhao ◽  
Changwei Yang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Predictive Index ◽  
Postoperative Shoulder Imbalance ◽  
Shoulder Imbalance ◽  
Postoperative Shoulder

scholarly journals A retrospective study to reveal factors associated with postoperative shoulder imbalance in patients with adolescent idiopathic scoliosis with double thoracic curve

2016 ◽  
Vol 18 (6) ◽  
pp. 744-752 ◽  
Author(s):  
Choon Sung Lee ◽  
Chang Ju Hwang ◽  
Eic Ju Lim ◽  
Dong-Ho Lee ◽  
Jae Hwan Cho
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Thoracic Curve ◽  
Corrective Surgery ◽  
Postoperative Shoulder Imbalance ◽  
Before And After ◽  
Shoulder Imbalance ◽  
Double Thoracic Curve ◽  
Postoperative Shoulder

OBJECTIVE Postoperative shoulder imbalance (PSI) is a critical consideration after corrective surgery for a double thoracic curve (Lenke Type 2); however, the radiographic factors related to PSI remain unclear. The purpose of this study was to identify the radiographic factors related to PSI after corrective surgery for adolescent idiopathic scoliosis (AIS) in patients with a double thoracic curve. METHODS This study included 80 patients with Lenke Type 2 AIS who underwent corrective surgery. Patients were grouped according to the presence [PSI(+)] or absence [PSI(−)] of shoulder imbalance at the final follow-up examination (differences of 20, 15, and 10 mm were used). Various radiographic parameters, including the Cobb angle of the proximal and middle thoracic curves (PTC and MTC), radiographic shoulder height (RSH), clavicle angle, T-1 tilt, trunk shift, and proximal and distal wedge angles (PWA and DWA), were assessed before and after surgery and compared between groups. RESULTS Overall, postoperative RSH decreased with time in the PSI(−) group but not in the PSI(+) group. Statistical analyses revealed that the preoperative Risser grade (p = 0.048), postoperative PWA (p = 0.028), and postoperative PTC/MTC ratio (p = 0.011) correlated with PSI. Presence of the adding-on phenomenon was also correlated with PSI, although this result was not statistically significant (p = 0.089). CONCLUSIONS Postoperative shoulder imbalance is common after corrective surgery for Lenke Type 2 AIS and correlates with a higher Risser grade, a larger postoperative PWA, and a higher postoperative PTC/MTC ratio. Presence of the distal adding-on phenomenon is associated with an increased PSI trend, although this result was not statistically significant. However, preoperative factors other than the Risser grade that affect the development of PSI were not identified by the study. Additional studies are required to reveal the risk factors for the development of PSI.

Excessive correction impacts postoperative shoulder imbalance in lenke type 5C adolescent idiopathic scoliosis

2020 ◽  
Vol 25 (5) ◽  
pp. 757-762
Author(s):  
Eijiro Okada ◽  
Teppei Suzuki ◽  
Satoru Demura ◽  
Toshiki Saito ◽  
Ayato Nohara ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Postoperative Shoulder Imbalance ◽  
Shoulder Imbalance ◽  
Postoperative Shoulder

An analysis of preoperative shoulder and neck balance and surgical outcome in 111 adolescent idiopathic scoliosis patients with two subtypes of Lenke 1 curves

2021 ◽  
Vol 34 (1) ◽  
pp. 37-44
Author(s):  
Chris Yin Wei Chan ◽  
Chee Kidd Chiu ◽  
Yun Hui Ng ◽  
Saw Huan Goh ◽  
Xin Yi Ler ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Cobb Angle ◽  
Surgical Outcome ◽  
Posterior Spinal Fusion ◽  
Current Treatment ◽  
Shoulder Balance ◽  
Significant Difference ◽  
Postoperative Shoulder Imbalance ◽  
Postoperative Shoulder

OBJECTIVEThe incidence of postoperative shoulder imbalance following posterior spinal fusion (PSF) is still high in Lenke 1 curves despite following current treatment recommendations for upper instrumented vertebra (UIV) selection. The objective of this retrospective study was to identify differences in preoperative shoulder balance and to report the surgical outcome of two subtypes of Lenke 1 curves (flexible vs stiff) in patients with adolescent idiopathic scoliosis (AIS).METHODSThe authors grouped patients’ curves as Lenke 1–ve (flexible) when their preoperative proximal thoracic side bending (PTSB) Cobb angle was < 15° and as Lenke 1+ve (stiff) when the PTSB Cobb angle was 15°–24.9°. The authors hypothesized that these two subtypes had distinct preoperative and postoperative shoulder and neck balance following PSF using pedicle screw constructs.RESULTSFifty patients had Lenke 1 (flexible) curves and 61 had Lenke 1 (stiff) curves. The mean preoperative T1 tilt for patients with Lenke 1 (flexible) was −4.9° ± 5.3°, and for those with Lenke 1 (stiff) curves it was −1.0° ± 5.3° (p < 0.001). Mean cervical axis (CA) was −0.1° ± 3.2° for Lenke 1 (flexible) curves and 2.3° ± 3.5° for Lenke 1 (stiff) curves (p < 0.001). Preoperative radiographic shoulder height (RSH) and clavicle angle (Cla-A) were similar between the two curve subtypes. Following surgery, there were significant differences between the subtypes in terms of T1 tilt (p < 0.001), RSH (p = 0.014), and Cla-A (p = 0.031). Interestingly, 41.0% of patients with a Lenke 1 (stiff) curve had +ve T1 tilt compared to 2.0% in Lenke 1 (flexible) group. Moreover, 26.2% of patients with the Lenke 1 (stiff) curve had +ve RSH compared to 12.0% of those with Lenke 1 (flexible) curves. And, 24.6% of patients with Lenke 1 (stiff) had +ve Cla-A compared to 10.0% of those with Lenke 1 (flexible) curves.CONCLUSIONSLenke 1 (flexible) and Lenke 1 (stiff) curves had distinct preoperative T1 tilt and CA measurements. Following PSF, the authors noted +ve T1 tilt in 41% of patients with Lenke 1 (stiff) curves versus 2.0% in those with Lenke 1 (flexible) curves. The authors also noted a significant difference in postoperative RSH and Cla-A measurements.

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