scholarly journals What is the impact of scoliotic correction on postoperative shoulder imbalance in severe and rigid scoliosis

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Shuo Yuan ◽  
Ning Fan ◽  
Yong Hai ◽  
Qichao Wu ◽  
Peng Du ◽  
...  
Keyword(s):  
Rate Ratio ◽  
Correction Rate ◽  
Postoperative Shoulder Imbalance ◽  
Post Operation ◽  
Shoulder Imbalance ◽  
Rate Ratios ◽  
Severe And Rigid Scoliosis ◽  
The Impact ◽  
Postoperative Shoulder

Abstract Background Although recent studies have investigated the risk factors for PSI, few studies have focused on the impact of scoliotic correction on postoperative shoulder imbalance (PSI), especially in severe and rigid scoliosis (SRS). The purpose of the study was to study the effect of scoliotic correction on PSI in SRS. Methods The preoperative, postoperative, and minimum 2-year follow-up radiographs of 48 consecutive patients with SRS who underwent posterior spinal fusion surgery were evaluated. We regarded radiographic shoulder height (RSH) as a shoulder balance parameter and divided the patients into improved and aggravated groups of PSI from pre- to post-operation and from post-operation to last follow-up, respectively. In addition, patients were divided into nine groups based on the observed changes in PSI after surgery and at follow-up, and the correction rate ratios were calculated among the groups. Independent samples T test and Chi-squared test were performed between the improved and aggravated groups of PSI. Results After surgery, the proximal thoracic curve (PTC) flexibility (P = 0.040), correction rate of the main thoracic curve (MTC) (P = 0.010), and Cobb angle of the lumbar curve (LC) (P = 0.037) were significantly higher, while the ratio of the correction rate of the PTC to the MTC (P = 0.042) was smaller in the aggravated group. At follow-up, the improved group had significantly larger PTC flexibility (P = 0.006), larger ratio of the correction rate of PTC to MTC (P = 0.046), a larger ratio correction rate of PTC to LC (P = 0.027), and a smaller correction rate of LC (P = 0.030). The correction rate ratios of the groups after surgery were as follows: negative to negative (N-N) (1.08) > negative to balance (N-B) (0.96) > negative to positive (N-P) (0.67), B-N (1.26) > B-B (0.94) > B-P (0.89), and P-N (0.34) > P-P (0.83). The order of the correction rate ratio at follow-up was as follows: N-N (0.96) > N-B (0.51), B-B (0.97) > B-P (0.90), and P-B (0.87) > P-P (0.84). Conclusion Harmonizing the correction rate ratio of the PTC, MTC, and LC should be recommended for intraoperative correction and postoperative compensation of PSI. In addition, greater PTC flexibility plays an important role in the spontaneous correction and compensation of PSI in SRS.

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 Upper End Vertebra of Proximal Thoracic Curve At T1 is a Novel Risk Factor of Postoperative Shoulder Imbalance in Lenke Type 2 Adolescent Idiopathic Scoliosis

2021 ◽  
pp. 219256822110230
Author(s):  
Norihiro Isogai ◽  
Mitsuru Yagi ◽  
Nao Otomo ◽  
Yoshihiro Maeda ◽  
Satoshi Suzuki ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Adolescent Idiopathic Scoliosis ◽  
Univariate Analysis ◽  
Postoperative Shoulder Imbalance ◽  
Shoulder Imbalance ◽  
Grade 3 ◽  
Postoperative Shoulder

Study Design: Retrospective single-center study. Objective: We investigated the risk factors of postoperative shoulder imbalance (PSI) in patients with Lenke type 2 adolescent idiopathic scoliosis (AIS) including the position of preoperative upper end vertebra (UEV). Methods: Seventy-five patients with Lenke type 2 AIS who underwent posterior correction and fusion surgeries from 2008 to 2018 were included. We included only patients whose upper instrumented vertebrae were at T2. The patients were divided into 2 groups based on radiographic shoulder height (RSH) at final follow-up, namely PSI group and non-PSI group, and PSI was defined as RSH > 10 mm. UEV, RSH, Cobb angle, curve flexibility, T1 and T2 tilt, correction rate, Risser grade, Scoliosis Research Society-22 scores, and demographic data were compared between the groups using independent t-tests or chi-square tests. Variables with P value < 0.20 in univariate analysis were assessed in logistic regression analysis. Results: Thirty-four patients in the PSI group and 37 patients in the non-PSI group were analyzed. Univariate analysis revealed that there were more patients with UEV at T1 (PSI: 85%, non-PSI: 54%, P < 0.01) and Risser grade ≥ 3 (PSI: 88%, non-PSI: 62%; P < 0.05) in the PSI group than in the non-PSI group. Logistic regression analysis revealed that UEV at T1 (odds ratio [OR] = 4.1 [1.2–14.4], P < 0.05) and Risser grade ≥ 3 (OR = 3.9 [1.1–14.5], P < 0.05) are significantly associated with PSI. Conclusions: UEV at T1 and Risser grade ≥ 3 at the time of surgery are significant risk factors of PSI.

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.

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