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.

scholarly journals Preoperative “Cervical Axis” Deviation Increases the Risk of Distal Adding-On Following Surgery in Lenke 1 and 2 Adolescent Idiopathic Scoliosis Patients

2021 ◽  
pp. 219256822199864
Author(s):  
Chris Yin Wei Chan ◽  
Pei Ying Ch’ng ◽  
Sin Ying Lee ◽  
Weng Hong Chung ◽  
Chee Kidd Chiu ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Cobb Angle ◽  
Predictive Factors ◽  
Multivariate Logistic Regression Analysis ◽  
Shoulder Balance ◽  
Lowest Instrumented Vertebra ◽  
The Relationship ◽  
Postoperative Shoulder

Study Design: Retrospective. Purpose: To evaluate the relationship between shoulder/ neck imbalance with distal adding-on phenomenon and to identify other risk factors in Lenke 1 and 2 (non-AR curves) adolescent idiopathic scoliosis (AIS) patients. Methods: 100 Lenke 1 and 2 AIS patients with lowest instrumented vertebra (LIV) cephalad to or at L1 were recruited. Medial shoulder/ neck balance was represented by T1-tilt and cervical axis (CA). Lateral shoulder balance was represented by clavicle angle (Cla-A) and radiographic shoulder height (RSH). Distal adding-on phenomenon was diagnosed when there was disc wedging below LIV of >5o at final follow-up. Predictive factors and odds ratio were derived using univariate and multivariate logistic regression analysis. Results: Mean age of this cohort was 15.9 ± 4.4 years. Mean follow-up duration was 30.9 ± 9.6 months. Distal adding-on phenomenon occurred in 19 patients (19.0%). Only Risser grade, preoperative CA and final follow-up lumbar Cobb angle were the independent factors. A positive preoperative CA deviation increased the odds of distal adding-on by 5.4 times (95% CI 1.34-21.51, P = 0.018). The mean immediate postoperative T1-tilt, CA, RSH and Cla-A were comparable between the group with distal adding-on and the group without. Conclusion: Distal adding-on phenomenon occurred in 19.0% of patients. Preoperative “Cervical Axis” was an important factor and it increased the risk of distal adding-on by 5.4 times. Other significant predictive factors were Risser grade and lumbar Cobb angle at final follow-up. Immediate postoperative shoulder or neck imbalance was not a significant factor for postoperative distal adding-on phenomenon.

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

Association of Postoperative Shoulder Balance With Adding-on in Lenke Type II Adolescent Idiopathic Scoliosis

Spine ◽  
2014 ◽  
Vol 39 (12) ◽  
pp. E705-E712 ◽  
Author(s):  
Kai Cao ◽  
Kota Watanabe ◽  
Naobumi Hosogane ◽  
Yoshiaki Toyama ◽  
Ikuho Yonezawa ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Type Ii ◽  
Shoulder Balance ◽  
Postoperative Shoulder

scholarly journals Changes in Thoracic Torsion in Adolescent Idiopathic Scoliosis Patients Within a 2-year Postoperative Period

2021 ◽  
Author(s):  
yonggang wang ◽  
Dongmin Wang ◽  
Xuewen Kang ◽  
Zhanjun Ma ◽  
Yingping Ma ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Cobb Angle ◽  
Postoperative Period ◽  
Structural Model ◽  
Three Dimensional ◽  
Posterior Spinal Fusion ◽  
Scoliosis Surgery ◽  
Thoracic Cavity ◽  
Radiological Parameters

Abstract Background: Scoliosis can cause deformities of the rib cage. The three-dimensional (3D) shape of the rib-vertebral-sternal complex matches that of the thoracic cavity and is visualized as an elastic structural model that is approximately cubic in shape. This study was performed to evaluate the changes in thoracic torsion by measuring radiological parameters.Methods: Forty-four patients with adolescent idiopathic scoliosis (AIS) with a main right thoracic curvature underwent posterior spinal fusion (PSF), and radiological parameters of the spine and thorax were evaluated. Results: The correction of preoperative, immediately postoperative, and 2-year postoperative MT-Cobb angles were 64% and 66%. The correction of T1–T12 heights were 10% and 12%. The correction of RVAD was 59% immediately postoperatively and 52% at 2 year postoperatively. The correction of RH was 59% immediately postoperatively and 52% at 2 year postoperatively. The correction of AVB-R was 23% immediately postoperatively and 25% at 2 year postoperatively. From the above results, all radiological parameters were significantly different immediately and at 2 year postoperatively compared to preoperatively (p < 0.001). There were significant correlations between MT-Cobb angle and T1–T12 height (p < 0.001), RVAD (p < 0.001), RH (p < 0.001), and AVB-R (p < 0.001).Conclusion: Most cases of mild and moderate scoliosis surgery also includes the correction of thoracic torsion. PSF appears to be effective at correcting scoliosis, and the correction of thoracic torsion also plays an important role.

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