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Kinoshita Y, Matsumura A, Namikawa T, Hoshino M, Hori Y, Nakamura H. Analyzing Factors Associated with Postoperative Shoulder Imbalance in Lenke2 Adolescent Idiopathic Scoliosis (Retrospective Cohort Study). World Neurosurg 2024:S1878-8750(24)01013-1. [PMID: 38897402 DOI: 10.1016/j.wneu.2024.06.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Accepted: 06/10/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVE To assess the incidence of postoperative shoulder imbalance (PSI) following posterior spinal fusion surgeries in adolescent idiopathic scoliosis (AIS) with Lenke2 and calculate the risk factors for PSI. METHODS Sixty patients who underwent surgery for Lenke2 AIS with more than 2-year follow-up were selected. Radiographic parameters were measured before and after surgery, and at the latest follow-up. The patients were divided into PSI and non-PSI groups, with PSI defined as a radiographic shoulder height >15 mm on postoperative radiography. The factors were compared between the PSI and non-PSI groups using the Mann-Whitney U test or chi-squared test. Finally, explanatory variables were chosen for multivariate analysis based on previous studies. RESULTS The PSI group comprised 17 patients. Most PSI cases spontaneously improved, and four patients (6.7%) showed PSI at the final follow-up. Univariate analysis indicated significant differences between postoperative T1 tilt (9.00 ± 5.17 vs. 5.67 ± 4.02, P = 0.029), UIV tilt (1.94 ± 4.49 vs. -1.00 ± 5.04, P = 0.039), and ΔT1 tilt (4.82 ± 3.99 vs. 2.12 ± 3.77, P = 0.026). Multivariate logistic regression analysis indicated that ΔT1 tilt had a significant positive relationship with PSI occurrence (coefficient = 0.2541, 95% confidence interval [CI]: 0.023 to 0.485, P = 0.0310). This study found no significant differences in the SRS-22 scores at the final follow-up. CONCLUSIONS The incidence of PSI for Lenke2 AIS was 28.3% at 1 week postoperatively and 6.7% at the final follow-up. ΔT1 tilt was a risk factor for PSI. Adjustment of the T1 tilt during surgery was considered useful for the prevention of PSI.
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Affiliation(s)
- Yuki Kinoshita
- Department of Orthopedic Surgery, Scoliosis Center, Osaka City General Hospital, Osaka, Japan
| | - Akira Matsumura
- Department of Orthopedic Surgery, Scoliosis Center, Osaka City General Hospital, Osaka, Japan.
| | - Takashi Namikawa
- Department of Orthopedic Surgery, Scoliosis Center, Osaka City General Hospital, Osaka, Japan
| | - Masatoshi Hoshino
- Department of Orthopedic Surgery, Scoliosis Center, Osaka City General Hospital, Osaka, Japan
| | - Yusuke Hori
- Department of Orthopedic Surgery, Scoliosis Center, Osaka City General Hospital, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
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Li J, Tseng C, Yuan Y, Jiang D, Qian Z, Hu Z, Zhu Z, Qiu Y, Liu Z. Determining the association between the radiographic parameters and the SRS-22 scores in Chinese female patients with adolescent idiopathic scoliosis: does curve pattern matter? Br J Neurosurg 2024; 38:349-355. [PMID: 33491493 DOI: 10.1080/02688697.2021.1875396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 06/16/2020] [Accepted: 01/08/2021] [Indexed: 10/22/2022]
Abstract
Background: The Scoliosis Research Society (SRS)-22 outcomes have been shown to be correlated with radiographic parameter of adolescent idiopathic scoliosis (AIS). A recent study suggested that curve patterns might play a role in assessing the influence of deformity on patient's reported outcomes. The aim of this study was to examine the relationship between radiographic parameters and SRS-22 questionnaire outcomes in female patients with adolescent AIS among the Chinese population based on five curve patterns.Patients and Methods: The radiographic data and SRS-22 questionnaires of 259 female AIS patients were reviewed. Radiographic measurements included: Cobb angle of the major curve, T1 tilt angle, apical vertebral rotation, apical vertebral translation (AVT), thoracic kyphosis, and lumbar lordosis. Curve patterns included single thoracic (T), single thoracolumbar/lumbar (TL), double thoracic (DT), double major (DM), and triple major (TM). The correlation between radiographic measurements and each domain in SRS-22 was determined by Pearson's correlation coefficient.Results: The curve magnitude and AVT of the major curve were found to be significantly correlated with the self-image domain in all cases (Cobb angle: r = -0.426, p = 0.002; AVT: r = -0.281, p=0.006) and in all curve patterns except for TM. Compared to other groups, the TM group had a significantly larger major curve than the DT group and TL group (p ≤ 0.004). In TM group, the self-image scores were lower than TL group (p =0.018), and the function scores were lower than that in T, TL (p < 0.001) and DM groups (p =0.013). In the DT group, the T1 tilt was significantly correlated with the self-image domain (r = -0.376, p =0.004). In the T group, coronal curve magnitude was significantly correlated with function domain (r = -0.397, p < 0.001).Conclusion: Our findings suggested curve patterns should be considered in evaluating the correlations between radiographic parameters and SRS-22 outcomes in patients with AIS.
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Affiliation(s)
- Jie Li
- Department of Spine Surgery, Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Changchun Tseng
- Department of Spine Surgery, Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Yiwen Yuan
- Department of Spine Surgery, Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Dengxu Jiang
- Department of Spine Surgery, Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Zhikai Qian
- Department of Spine Surgery, Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Zongshan Hu
- Department of Spine Surgery, Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Zezhang Zhu
- Department of Spine Surgery, Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Yong Qiu
- Department of Spine Surgery, Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Zhen Liu
- Department of Spine Surgery, Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
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LaBarge ME, Waddell WH, Chanbour H, Stephens BF, Martus JE, Mencio GA, Louer CR. Flexibility-tilt agreement best predicts shoulder balance following posterior spine fusion for adolescent idiopathic scoliosis. Spine Deform 2024; 12:391-401. [PMID: 38123895 DOI: 10.1007/s43390-023-00797-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 11/18/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE We propose a novel concept, called flexibility-tilt agreement (FTA), which could be applied intra-operatively to improve shoulder balance following posterior spine fusion for Adolescent Idiopathic Scoliosis (AIS). We retrospectively applied this concept to a cohort with thoracic-only curves, seeking to: (1) evaluate the impact of FTA and other peri-operative variables on post-operative shoulder balance, and (2) evaluate deformity characteristics associated with achieving FTA. METHODS A single-institution registry was queried for patients undergoing PSF from 2000 to 2017 with main thoracic and double thoracic curves with at least 2-year follow-up. Flexibility was defined as the Cobb angle of the unfused proximal thoracic curve (cephalad to chosen UIV) on pre-operative bender. Tilt refers to post-operative UIV tilt angle. FTA means these values cancel (Flexibility + Tilt = 0 ± 5°). Logistic regression was performed to determine the association between peri-operative variables and shoulder balance. RESULTS One hundred and sixty-one patients were included, mean age 13.6 years old, and 47-month mean follow-up. FTA was achieved in 74 (46%) patients and was associated with post-operative (OR = 4.59) and final (OR = 6.98) medial shoulder balance with a threshold of 6° (AUC = 0.77, p = 0.038). FTA was the best predictor of shoulder balance of all tested variables. CONCLUSION Patients that showed flexibility-tilt agreement, or FTA, had vastly increased odds of medial and lateral shoulder balance at a minimum of 2-year follow-up for all thoracic curves. Future studies can evaluate whether applying FTA to determine intra-operative corrective maneuvers prospectively leads to improvements in shoulder balance. LEVEL OF EVIDENCE Level III-retrospective comparative study.
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Affiliation(s)
- Matthew E LaBarge
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, 2200 Children's Way, Suite 4202, Nashville, TN, 37232, USA
| | - William H Waddell
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, 2200 Children's Way, Suite 4202, Nashville, TN, 37232, USA
| | - Hani Chanbour
- Department of Neurologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Byron F Stephens
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, 2200 Children's Way, Suite 4202, Nashville, TN, 37232, USA
- Department of Neurologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jeffrey E Martus
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, 2200 Children's Way, Suite 4202, Nashville, TN, 37232, USA
| | - Gregory A Mencio
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, 2200 Children's Way, Suite 4202, Nashville, TN, 37232, USA
| | - Craig R Louer
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, 2200 Children's Way, Suite 4202, Nashville, TN, 37232, USA.
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Lee SY, Ch'ng PY, Wong TS, Ling XW, Chung WH, Chiu CK, Chan CYW, Lean ML, Kwan MK. Patients' Perception and Satisfaction on Neck and Shoulder Imbalance in Adolescent Idiopathic Scoliosis. Global Spine J 2023; 13:752-763. [PMID: 33823628 DOI: 10.1177/21925682211007795] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Cross-sectional. OBJECTIVES To evaluate the perception and satisfaction among adolescent idiopathic scoliosis (AIS) patients on Neck Tilt with Medial Shoulder Imbalance and Lateral Shoulder Imbalance. METHODS Lenke 1 and 2 AIS patients were stratified into 6 groups of preoperative/ postoperative Balanced (B), Lateral Shoulder Imbalance (LSI) (>2 cm), and Neck Tilt with Medial Shoulder Imbalance (NT) (Grade 3). Patients were interviewed using Modified Neck and Shoulder Appearance and SRS-22r questionnaires. T1 tilt, Cervical Axis (CA), Clavicle Angle (Cla-A) and Radiographic Shoulder Height (RSH) were measured. RESULTS A total of 120 Lenke 1 and 2 AIS patients were recruited. NT patients were aware and unhappy with their abnormal neck with medial shoulder appearances (P < .001). Similarly, LSI patients were aware and unhappy with their abnormal lateral shoulder appearances (P < .001). NT group had larger preoperative/ postoperative T1 tilt (9.2 ± 5.0°; 9.5 ± 5.3°) and CA (4.6 ± 3.1°; 7.0 ± 2.0°) (P < .01). LSI group had larger preoperative/ postoperative Cla-A (4.8 ± 2.8°; 4.0 ± 1.3°) and RSH (20.1 ± 9.4 mm; 17.0 ± 6.6 mm) (P < .001). Postoperative B group scored higher in overall SRS-22r scores, self-image and satisfaction domains (4.2 ± 0.3; 4.0 ± 0.5; 4.4 ± 0.5) while preoperative LSI scored the lowest comparatively (3.5 ± 0.4; 2.4 ± 0.5; 3.3 ± 0.5) (P < .001). CONCLUSION NT and LSI were major concerns among AIS patients. Both NT and LSI groups were unhappy with their appearances. NT group had larger T1 tilt/ CA whereas LSI group had larger Cla-A/ RSH. Postoperative B group scored higher in overall SRS-22r scores, self-image and satisfaction domains.
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Affiliation(s)
- Sin Ying Lee
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Pei Ying Ch'ng
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Tat Seng Wong
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Xiu Wen Ling
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Weng Hong Chung
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Chee Kidd Chiu
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Chris Yin Wei Chan
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Mei Li Lean
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
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Erşen Ö, Yüzügüldü U, Başak AM, Güveli R, Ege T. Effect of clinical and radiological parameters on the quality of life in adult patients with untreated adolescent idiopathic scoliosis: a cross-sectional study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:1196-1203. [PMID: 36797417 DOI: 10.1007/s00586-023-07571-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/02/2023] [Accepted: 01/31/2023] [Indexed: 02/18/2023]
Abstract
PURPOSE The aim of this study is to evaluate the factors that affect health-related quality of life (HRQoL) in untreated adolescent idiopathic scoliosis (AIS) patients in adulthood. We investigate the effect of clinical and radiological parameters on the SRS-22 results. METHODS A total of 286 untreated adolescent idiopathic scoliosis patients at adult age between April 2021 and April 2022 who were admitted to our clinic were included in the study. Rotational deformities were evaluated with a scoliometer. Cobb angles, coronal balance, clavicle angle, coronal pelvic tilt, trunk shift, and apical vertebral translation were measured in standing anteroposterior X-rays. The effect of each clinical and radiological parameter on SRS-22 results was evaluated. RESULTS No correlation was found between gender, age, curve type, presence of gibbosity or diagnosis time, and SRS-22 scores. A negative correlation was found between the BMI of the patients and the self-image scores (r = - 0.246, p < 0.01) and function scores (r = - 0.193, p < 0.05). Main thoracic (MT) gibbosity negatively correlates with self-image and total SRS-22 scores. Also, negative correlations were found between lumbar/thoracolumbar (LTL) gibbosity, function, and pain scores. MT Cobb angle magnitude was negatively correlated with self-image, mental health, and total SRS-22 scores. There were negative correlations between clavicle angle and mental health score, coronal pelvic tilt and self-image score, and apical vertebral translation and pain score. CONCLUSION BMI, MT gibbosity, LTL gibbosity, MT Cobb angle, clavicle angle, coronal pelvic tilt, and apical vertebral translation were negatively correlated with SRS-22 domains in untreated AIS patients in adulthood.
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Affiliation(s)
- Ömer Erşen
- Department of Orthopedics, Gülhane School of Medicine, Health Sciences University, Ankara, Turkey.
| | - Uğur Yüzügüldü
- Department of Orthopedics, Gülhane School of Medicine, Health Sciences University, Ankara, Turkey
| | - Ali Murat Başak
- Department of Orthopedics, Gülhane School of Medicine, Health Sciences University, Ankara, Turkey
| | - Rıfat Güveli
- Department of Public Health, School of Medicine, Erciyes University, Kayseri, Turkey
| | - Tolga Ege
- Department of Orthopedics, Gülhane School of Medicine, Health Sciences University, Ankara, Turkey
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Moorthy V, Goh GS, Guo CM, Tan SB, Chen JLT, Soh RCC. Shoulder Balance Following Correction Surgery for Adolescent Idiopathic Scoliosis: When Is It Achieved and Does the Type of Construct Matter? Clin Spine Surg 2022; 35:E175-E180. [PMID: 34379376 DOI: 10.1097/bsd.0000000000001154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 12/22/2020] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This is a retrospective study. OBJECTIVE This study aims to determine (1) when shoulder rebalancing occurs after adolescent idiopathic scoliosis (AIS) correction surgery and (2) whether shoulder asymmetry was influenced by the use of pedicle screws or hooks. SUMMARY OF BACKGROUND DATA Postoperative shoulder imbalance is an important outcome of AIS correction surgery as it may influence a patient's appearance and satisfaction. MATERIALS AND METHODS Seventy AIS patients undergoing AIS correction surgery at a single institution were retrospectively reviewed. Radiographic parameters were measured from anteroposterior x-rays at preoperative, immediate postoperative, 6 months postsurgery, and 12 months postsurgery. Shoulder parameters measured were: radiographic shoulder height (RSH), clavicle angle, coracoid height difference (CHD), and T1 tilt. The Cobb angle of the proximal thoracic curve, major thoracic curve, and thoracolumbar/lumbar curve. The percentage of correction was also calculated. RESULTS Lateral shoulder asymmetry (RSH and CHD) changed significantly from preoperative to up to 6 months postsurgery. T1 tilt, a measure of medial shoulder asymmetry, did not change significantly. Postoperatively, the hook group attained significantly better shoulder balance than the screw group in terms of RSH and CHD up to 12 months postsurgery. However, the percentage correction of the major thoracic curve was significantly greater in the screw group than the hook group (hook: 62.2±18.4% vs. screw: 76.0±16.0%, P=0.007). CONCLUSIONS Lateral shoulder rebalancing occurs up to 6 months after surgery. While thoracic pedicle screws offer greater correction of major AIS curves, hook constructs offer better postoperative shoulder symmetry. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Vikaesh Moorthy
- Yong Loo Lin School of Medicine, National University Singapore
| | - Graham S Goh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Chang-Ming Guo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Seang-Beng Tan
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - John Li-Tat Chen
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
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Kurra S, Cahill PJ, Albanese SA, Betz RR, Toole T, Lavelle WF. Evaluation of shoulder balance in early onset scoliosis after definitive fusion and comparison with adolescent idiopathic scoliosis shoulder balance. Spine Deform 2022; 10:183-188. [PMID: 34347286 DOI: 10.1007/s43390-021-00393-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/24/2021] [Indexed: 02/10/2023]
Abstract
STUDY DESIGN The Children Spine Study Group registry was queried for early onset scoliosis (EOS) patients who had final definitive spinal fusion after their scoliosis was managed with either growing rods or VEPTR. The Harms Study Group registry was queried for adolescent idiopathic scoliosis (AIS) patients who had definitive fusion OBJECTIVE: The goal is to assess shoulder alignment in EOS patients after a definitive fusion and how these radiographic outcomes relate to the more familiar situation of post-definitive fusions shoulder alignment in AIS patients. BACKGROUND EOS is a challenging pathology to manage. Numerous components are important in the success of spinal surgery for this population. Shoulder balance is a one of the components that is easily seen by the patient. Recently, the importance of its relationship to patient satisfaction has received greater attention. METHODS Sample size: n = 145 (EOS (n = 34) and AIS (n = 111)). Shoulder balance parameters (SBP) of clavicular angle (CA), coracoid height difference (CHD), clavicular tilt angle difference (CTAD), and clavicle-rib cage intersection difference (CRID) measurements were measured from the reviewed radiographs and documented pre-definitive, post-definitive and 2-year follow-up measures. Shoulder balance parameters were compared between EOS and AIS cohorts at documented intervals. RESULTS EOS mean pre-definitive fusion SBPs (CA, CTAD, CRID, CHD) were significantly higher compared to AIS, p = 0.004, 0.003, < 0.001, < 0.001, respectively. Significant post-definitive fusion corrections were noticed for CTAD (0.01), CHD (0.01), nearly significant CA (0.07), non-significant CRID in EOS patients. In AIS patients, no significant corrections were noticed for CA, CTAD, CHD and but significant for CRID (0.02). At post-definitive and 2-year follow-up, CA, CRID, CHD were not significant between cohorts, but CTAD (< 0.01) was significantly higher in EOS cohort at final follow-up. CONCLUSION Post-definitive and 2-year follow-up shoulder balance for EOS patients was not significantly different from AIS patients. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Swamy Kurra
- Department of Orthopedics, SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA
| | - Patrick J Cahill
- Division of Orthopaedics, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Stephen A Albanese
- Department of Orthopedics, SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA
| | - Randal R Betz
- Institute for Spine and Scoliosis, 3100 Princeton Pike, Lawrenceville, NY, 08648, USA
| | - Thomas Toole
- SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA
| | - William F Lavelle
- Department of Orthopedics, SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA.
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Bram JT, Mehta N, Flynn JM, Anari JB, Baldwin KD, Yaszay B, Pahys JM, Cahill PJ. Sinister! The high pre-op left shoulder is less likely to be radiographically balanced at 2 years post-op. Spine Deform 2021; 9:451-460. [PMID: 33201494 DOI: 10.1007/s43390-020-00236-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 10/19/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE AIS patients consider shoulder balance an important cosmetic outcome after surgery. We examined the impact of preoperative left shoulder elevation (LSE) and choice of upper instrumented vertebra (UIV) on postoperative shoulder imbalance (PostSI). METHODS This was a retrospective cohort study utilizing a prospective AIS database. Patients had Lenke type 1-4 curves and preoperative shoulder height ≥ 1.0 cm. Patients with preoperative LSE and right shoulder elevation (RSE) were compared. Shoulder height difference < 1 cm was considered 'mild', 1-2 cm was 'moderate', and ≥ 2.0 cm was 'severe'. RESULTS 407 patients had ≥ 1.0 cm imbalance preoperatively, with 88 (21.6%) LSE. There were no differences in gender (p = 0.855) or age (p = 0.477). Patients with LSE more frequently had Lenke type 2 curves (43.2% vs 16.3%, p < 0.001), while preoperative RSE averaged 1.9 ± 0.9 cm versus 1.6 ± 0.5 cm for LSE (p < 0.001). Those with LSE more often had severe PostSI at 2 years (30.7% vs 5.0%, p < 0.001), and only 26.1% of patients with severe preoperative LSE corrected to mild. In contrast, most patients with RSE had mild PostSI regardless of initial imbalance. When examining only LSE patients, there was no difference in preoperative SH by final UIV (p = 0.101). Further, UIV choice did not impact the proportion of severely unbalanced patients postoperatively (p = 0.446). A PTC > 34.5° was predictive of PostSI ≥ 2.0 cm for patients with preoperative LSE. CONCLUSION AIS patients with preoperative LSE are less likely to achieve level shoulders postoperatively. Choice of higher UIV did not affect postoperative shoulder imbalance in this cohort. A PTC > 34.5° was predictive of severe PostSI in patients with preoperative LSE. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Joshua T Bram
- The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Nishank Mehta
- The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - John M Flynn
- The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Jason B Anari
- The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Keith D Baldwin
- The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Burt Yaszay
- Rady Children's Hospital-San Diego, San Diego, CA, USA
| | - Joshua M Pahys
- Shriners Hospitals for Children-Philadelphia, Philadelphia, PA, USA
| | - Patrick J Cahill
- The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA.
- Robert M. Campbell Jr. Endowed Chair in Thoracic Insufficiency Syndrome, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Wood Building, 2nd floor, 34th Street and Civic Center Blvd., Philadelphia, PA, 19104, USA.
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Zuckerman SL, Cerpa M, Baum GR, Beauchamp EC, Sielatycki JA, Osorio J, Lombardi JM, Shimizu T, Lenke LG. Surgeons lack of agreement on determining preoperative radiographic and clinical shoulder balance in adolescent and adult idiopathic scoliosis patients. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:661-667. [PMID: 33386476 DOI: 10.1007/s00586-020-06702-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 11/23/2020] [Accepted: 12/12/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Preoperative shoulder balance is an important factor in determining the upper instrumented vertebrae (UIV). In adolescent and adult idiopathic scoliosis (AIS/AdIS) patients, we studied the intraobserver and interobserver reliability of spinal surgeons' assessment of preoperative shoulder balance using X-rays (XR) and anterior/posterior photographs. METHODS An observational review of a prospective multicenter database (AIS Lenke Type 1/5/6) and prospective single-institution database (AdIS) was conducted. Ten spine surgeons reviewed AIS cases; 12 spine surgeons reviewed AdIS cases. Surgeons rated the higher shoulder: left/right/same/unsure. Reliability was calculated using Fleiss' kappa coefficient. RESULTS Among 145 Type 1 AIS cases, intraobserver reliability was moderate-to-substantial: XR (κ = 0.59), anterior photographs (κ = 0.68), posterior photographs (k = 0.65). Interobserver reliability was fair to moderate for XR (κ = 0.31), anterior photographs (κ = 0.20), and posterior photographs (κ = 0.30). Among 52 Type 5/6 AIS cases, intraobserver reliability was substantial: XR (κ = 0.70), anterior photographs (κ = 0.76), posterior photographs (κ = 0.71). Interobserver reliability was fair to moderate for XR (κ = 0.49), anterior photographs (κ = 0.47), and posterior photographs (κ = 0.36). Among 66 AdIS cases, intraobserver reliability was substantial: XR (κ = 0.68), anterior photographs (κ = 0.67), posterior photographs (κ = 0.69). Interobserver reliability was moderate for XR (κ = 0.45), anterior photographs (κ = 0.43), posterior photographs (κ = 0.49). Within Type 1 AIS patients, attendings had better intraobserver reliabilities compared to fellows using X-rays (κ = 0.61 vs. 0.53), yet no effect of surgeon experience was seen with clinical photographs. CONCLUSION Though surgeons' ability to agree with themselves was moderate to substantial, surgeons' ability to agree with each other was fair to moderate. Combined measures to assess preoperative shoulder balance are needed for UIV selection.
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Affiliation(s)
- Scott L Zuckerman
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital At New York Presbyterian, New York, NY, USA.
| | - Meghan Cerpa
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital At New York Presbyterian, New York, NY, USA
| | - Griffin R Baum
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital At New York Presbyterian, New York, NY, USA
| | - Eduardo C Beauchamp
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital At New York Presbyterian, New York, NY, USA
| | - J Alex Sielatycki
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital At New York Presbyterian, New York, NY, USA
| | - Joseph Osorio
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital At New York Presbyterian, New York, NY, USA
| | - Joseph M Lombardi
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital At New York Presbyterian, New York, NY, USA
| | - Takayoshi Shimizu
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital At New York Presbyterian, New York, NY, USA
| | - Lawrence G Lenke
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital At New York Presbyterian, New York, NY, USA
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Abstract
STUDY DESIGN Cross-sectional. OBJECTIVE The aim of this study was to describe the self-experienced trunk appearance in individuals with and without idiopathic scoliosis. SUMMARY OF BACKGROUND DATA Idiopathic scoliosis is the most common spinal deformity. A large scoliotic deformity increases the risk of back pain and pulmonary dysfunction. The deformity has also a psychological impact. METHODS The pictorial part of the spinal appearance questionnaire (pSAQ) was administered to 1416 individuals with idiopathic scoliosis (386 untreated, 529 brace treated, 501 surgically treated) and 272 individuals without scoliosis from the general population. Comparisons were made between individuals with and without scoliosis, between treatment groups and sex in the scoliosis group. RESULTS Mean (95% confidence interval) age of the individuals with scoliosis was 36.2 (35.5-36.9) years and for the individuals without scoliosis 40.2 (37.9-42.4). pSAQ total was 12.3 (12.1-12.5) for individuals with scoliosis and 7.4 (7.3-7.6) for individuals without scoliosis (P < 0.001, adjusted for age and sex). pSAQ total was 11.5 (11.1-11.9) for untreated, 13.0 (12.6-13.3) for brace treated, and 12.3 (11.9-12.6) for surgically treated individuals (P < 0.001, adjusted for sex and curve size). The pSAQ total between males and females with idiopathic scoliosis did not differ (P = 0.22 adjusted for age and curve size). CONCLUSION This study shows that individuals with idiopathic scoliosis have more concern about their body appearance than individuals without scoliosis. Untreated individuals are not as bothered of their spinal appearance as treated individuals. Males and females with scoliosis do not differ significantly in the perception of their spinal appearance. LEVEL OF EVIDENCE 3.
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Menon KV, Tahasildar NS. What Constitutes Shoulder Imbalance in Adolescent Idiopathic Scoliosis? Aesthetic Threshold for Surgical Correction. World Neurosurg 2020; 138:e827-e838. [PMID: 32234356 DOI: 10.1016/j.wneu.2020.03.106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To determine what constitutes clinical shoulder imbalance and the aesthetic unsightliness of the torso region in patients with scoliosis. How can it be measured? Shoulder imbalance is one of the most perplexing problems in scoliosis. There are no standard clinical or radiologic criteria for diagnosing shoulder imbalance, and hence its impact and prevention are poorly understood. This prospective cohort study aims to determine the clinical parameters in the torso region that are most aesthetically disfiguring in scoliosis, and the measures with their threshold values that can define shoulder imbalance. METHODS Twenty-six consecutive patients with adolescent idiopathic scoliosis formed the patient cohort. Only preoperative clinical photographs (not x-rays) of these patients were used for the study. Forty random observers were asked to rate the shoulder disfigurement in these patients as acceptable or unacceptable. An independent researcher plotted and measured 10 different deformity markers on these photographs. Three regions of the torso, the neck, shoulder, and axillary region, were studied separately. Receiver operating characteristic analysis was used to determine significance of each measure. RESULTS The patients with unacceptable deformation had statistically significant values in each of the 3 regions. The patients with acceptable appearance also had several measures that proved significant. Threshold values for each of these parameters were established from the analysis. CONCLUSIONS Shoulder imbalance in scoliosis is defined based on 3 regions: the neck, shoulder, and axillary region. Each has a specific threshold for producing cosmetically unacceptable deformation and they can be measured on clinical photographs. Measurement of the shoulder level alone is less representative.
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Affiliation(s)
- K Venugopal Menon
- Department of Spine Service, Bharati Vidyapeeth Medical College, Dhankawadi, Punee, India.
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12
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Bivertebral autostable claws for the proximal fixation in thoracic adolescent idiopathic scoliosis surgery. Spine Deform 2020; 8:77-84. [PMID: 31950478 DOI: 10.1007/s43390-020-00040-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 05/19/2019] [Indexed: 10/25/2022]
Abstract
STUDY DESIGN Retrospective monocentric study. OBJECTIVES To report radiologic outcomes of a consecutive series of AIS patients, operated with a bivertebral autostable claw for the upper instrumentation over a 5-year period. The upper fixation represents the weakest part of long constructs because of local anatomy and the high pull-out forces. Various implants have been proposed, but proximal junctional failures (PJF) and shoulder imbalance still occur with variable incidence. The autostable claw is a new implant, safe, and low profile, combining the mechanical strength of hooks with the initial stability of pedicle screws. METHODS All AIS patients operated between January 2010 and July 2015 for a Lenke 1 or 2 curve with the bivertebral autostable claw were included. A minimum 2-year follow-up was required. Full-spine biplanar stereoradiographs were performed preoperatively, within 8 weeks postoperative and at latest examination. Local and global sagittal and coronal parameters were analyzed and complications were reported. RESULTS 237 patients (191 Lenke 1 and 46 Lenke 2) were included, with a mean follow-up of 4.1 ± 0.6 years. PJF occurred in 2 patients (0.8%), and radiologic PJKs were observed in 8.4% of the series. Shoulder balance was efficiently restored or maintained in 88.2%. CONCLUSIONS The bivertebral autostable claw is a safe and robust alternative to pedicle screws for proximal fixation in AIS long constructs. Compression and/or distraction can be applied to level shoulders, and mechanical failures remain rare at 4-year follow-up. LEVEL OF EVIDENCE IV.
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13
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Terheyden JH, Wetterkamp M, Gosheger G, Lange T, Schulze Bövingloh A, Schulte TL. Rasterstereography versus radiography for assessing shoulder balance in idiopathic scoliosis: A validation study relative to patients' self-image. J Back Musculoskelet Rehabil 2019; 31:1049-1057. [PMID: 29945339 DOI: 10.3233/bmr-170867] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Shoulder imbalance is a problem for scoliosis patients. Rasterstereography uses radiation-free surface topography to follow up these patients. Its use for assessing shoulder level has not been investigated earlier. OBJECTIVE This study aimed to determine the accuracy of shoulder assessment using rasterstereography (versus radiography) and to analyze its relationship with patients' self-image. METHODS In a cross-sectional setting, the reliability and validity of five rasterstereographic shoulder variables were measured in comparison with six radiographic shoulder parameters, using correlation analysis. The patients' self-perception was documented using the Scoliosis Research Society-22 (SRS-22) questionnaire and Trunk Appearance Perception Scale (TAPS). RESULTS Forty patients were included in the study. The test-retest reliability of all rasterstereographic shoulder parameters was excellent (ICC > 0.95). The validity was moderate in comparison with six radiographic parameters (highest coefficient: 0.582). The radiographic and rasterstereographic shoulder levels correlated with the results in the SRS-22 questionnaire (highest coefficient: -0.463) and TAPS (highest coefficient: 0.413). CONCLUSIONS Rasterstereography is a reliable and valid method for assessing shoulder level in idiopathic scoliosis. The parameters can be recommended as a complement to radiography and clinical evaluation for follow-up purposes. Radiographic and rasterstereographic shoulder parameters are significantly related to patients' self-perception. Shoulder variables thus need to be considered in scoliosis patients.
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Affiliation(s)
| | - Mark Wetterkamp
- Department of Orthopaedics and Trauma Surgery, St. Josef Hospital, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Georg Gosheger
- Department of Orthopaedics and Tumor Orthopaedics, Muenster University Hospital, 48149 Muenster, Germany
| | - Tobias Lange
- Department of Orthopaedics and Tumor Orthopaedics, Muenster University Hospital, 48149 Muenster, Germany
| | - Albert Schulze Bövingloh
- Department of Orthopaedics and Tumor Orthopaedics, Muenster University Hospital, 48149 Muenster, Germany
| | - Tobias L Schulte
- Department of Orthopaedics and Trauma Surgery, St. Josef Hospital, Ruhr-University Bochum, 44791 Bochum, Germany
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Duramaz A, Yılmaz S, Ziroğlu N, Bursal Duramaz B, Kara T. The effect of deformity correction on psychiatric condition of the adolescent with adolescent idiopathic scoliosis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:2233-2240. [PMID: 29802465 DOI: 10.1007/s00586-018-5639-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 04/14/2018] [Accepted: 05/17/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE The purpose of this prospective study was to evaluate the effects of deformity correction on body image, quality of life, self-esteem, depression and anxiety in patients with adolescent idiopathic scoliosis (AIS) who underwent surgery. METHODS Between June 2014 and July 2015, 41 consecutive patients who underwent surgery for AIS were compared with the control group of 52 healthy patients regarding the changes in the pre- and postoperative quality of life and psychiatric status of patients with deformity correction. Body Cathexis Scale (BCS), Pediatric Quality of Life Inventory (PedsQL), Children's Depression Inventory (CDI), Piers-Harris self-esteem questionnaire (PH-SEQ) and state-trait Anxiety Inventory for Children were used to evaluate the patients. RESULTS There was a significant decrease in postoperative first-year Cobb angle and trunkal shift imbalance compared with the preoperative values (p = 0.0001 and p = 0.0001). Postoperative first-year thoracic kyphosis angle and body height showed a significant increase according to preoperative values (p = 0.0001 and p = 0.0001). Postoperative PH-SEQ score and PedsQL total score showed a significant increase in the study group compared to the preoperative level, but no significant difference was found between the control group. Postoperative CDI score, BCS score, STAI-state and STAI-trait scores decreased significantly in the study group compared with preoperative scores. CONCLUSIONS Surgical correction of deformity in AIS provided significant improvements regarding quality of life and psychiatric condition. Spinal surgeons should be aware of the possible psychological problems of AIS patients and should keep in mind that deformity correction not only improves physical health but also improves mental health. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Altuğ Duramaz
- Department of Orthopedics and Traumatology, Bakırköy Dr. Sadi Konuk Education and Research Hospital, Tevfik Sağlam St. Number 11, 34147, Bakırköy, Istanbul, Turkey.
| | - Semra Yılmaz
- Department of Child and Adolescent Psychiatry, Bakırköy Dr. Sadi Konuk Education and Research Hospital, Tevfik Sağlam St. Number 11, 34147, Bakırköy, Istanbul, Turkey
| | - Nezih Ziroğlu
- Department of Orthopedics and Traumatology, Bakırköy Dr. Sadi Konuk Education and Research Hospital, Tevfik Sağlam St. Number 11, 34147, Bakırköy, Istanbul, Turkey
| | - Burcu Bursal Duramaz
- Department of Pediatric Infectious Diseases, Bezmiâlem Vakıf University, Adnan Menderes Avenue, Vatan Street, 34093, Fatih, Istanbul, Turkey
| | - Tayfun Kara
- Department of Child and Adolescent Psychiatry, Bakırköy Dr. Sadi Konuk Education and Research Hospital, Tevfik Sağlam St. Number 11, 34147, Bakırköy, Istanbul, Turkey
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Stolinski L, Kozinoga M, Czaprowski D, Tyrakowski M, Cerny P, Suzuki N, Kotwicki T. Two-dimensional digital photography for child body posture evaluation: standardized technique, reliable parameters and normative data for age 7-10 years. SCOLIOSIS AND SPINAL DISORDERS 2017; 12:38. [PMID: 29276784 PMCID: PMC5738151 DOI: 10.1186/s13013-017-0146-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 12/04/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Digital photogrammetry provides measurements of body angles or distances which allow for quantitative posture assessment with or without the use of external markers. It is becoming an increasingly popular tool for the assessment of the musculoskeletal system. The aim of this paper is to present a structured method for the analysis of posture and its changes using a standardized digital photography technique. MATERIAL AND METHODS The purpose of the study was twofold. The first one comprised 91 children (44 girls and 47 boys) aged 7-10 (8.2 ± 1.0), i.e., students of primary school, and its aim was to develop the photographic method, choose the quantitative parameters, and determine the intraobserver reliability (repeatability) along with the interobserver reliability (reproducibility) measurements in sagittal plane using digital photography, as well as to compare the Rippstein plurimeter and digital photography measurements. The second one involved 7782 children (3804 girls, 3978 boys) aged 7-10 (8.4 ± 0.5), who underwent digital photography postural screening. The methods consisted in measuring and calculating selected parameters, establishing the normal ranges of photographic parameters, presenting percentile charts, as well as noticing common pitfalls and possible sources of errors in digital photography. RESULTS A standardized procedure for the photographic evaluation of child body posture was presented. The photographic measurements revealed very good intra- and inter-rater reliability regarding the five sagittal parameters and good reliability performed against Rippstein plurimeter measurements. The parameters displayed insignificant variability over time. Normative data were calculated based on photographic assessment, while the percentile charts were provided to serve as reference values. The technical errors observed during photogrammetry are carefully discussed in this article. CONCLUSIONS Technical developments are allowed for the regular use of digital photogrammetry in body posture assessment. Specific child positioning (described above) enables us to avoid incidentally modified posture. Image registration is simple, quick, harmless, and cost-effective. The semi-automatic image analysis, together with the normal values and percentile charts, makes the technique reliable in terms of child's posture documentation and corrective therapy effects' monitoring.
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Affiliation(s)
- L. Stolinski
- Department of Spine Disorders and Pediatric Orthopedics, University of Medical Sciences, 28 Czerwca 1956r. no. 135/147, 61-545 Poznan, Poland
- Rehasport Clinic, Poznan, Poland
- Rehasport Clinic Licensed Rehabilitation Center, Skierniewice, Poland
| | - M. Kozinoga
- Department of Spine Disorders and Pediatric Orthopedics, University of Medical Sciences, 28 Czerwca 1956r. no. 135/147, 61-545 Poznan, Poland
- Rehasport Clinic, Poznan, Poland
| | - D. Czaprowski
- Department of Physiotherapy, Józef Rusiecki University College, Olsztyn, Poland
- Center of Body Posture, Olsztyn, Poland
| | - M. Tyrakowski
- Department of Orthopaedics, Pediatric Orthopaedics and Traumatology, The Centre of Postgraduate Medical Education in Warsaw, Otwock, Poland
| | - P. Cerny
- Faculty of Health Studies, University of West Bohemia, Pilsen, Czech Republic
- Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
- ORTOTIKA, s. r. o, Faculty at Motol University Hospital, Prague, Czech Republic
| | - N. Suzuki
- Scoliosis Center, Medical Scanning Tokyo, Tokyo, Japan
| | - T. Kotwicki
- Department of Spine Disorders and Pediatric Orthopedics, University of Medical Sciences, 28 Czerwca 1956r. no. 135/147, 61-545 Poznan, Poland
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Cheshire J, Gardner A, Berryman F, Pynsent P. Do the SRS-22 self-image and mental health domain scores reflect the degree of asymmetry of the back in adolescent idiopathic scoliosis? SCOLIOSIS AND SPINAL DISORDERS 2017; 12:37. [PMID: 29238754 PMCID: PMC5724343 DOI: 10.1186/s13013-017-0144-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 10/31/2017] [Indexed: 11/10/2022]
Abstract
Background Patient-reported outcomes are becoming increasingly recognised in the management of patients with adolescent idiopathic scoliosis (AIS). Integrated Shape Imaging System 2 (ISIS2) surface topography is a validated tool to assess AIS. Previous studies have failed to demonstrate strong correlations between AIS and patient-reported outcomes highlighting the need for additional objective surface parameters to define the deformities associated with AIS. The aim of this study was to examine whether the Scoliosis Research Society-22 (SRS-22) outcome questionnaire reflects the degree of measurable external asymmetry of the back in AIS and thus is a measure of patient outcome for external appearance. Methods A total of 102 pre-operative AIS patients were identified retrospectively. Objective parameters were measured using ISIS2 surface topography. The associations between these parameters and the self-image and mental health domains of the SRS-22 questionnaire were investigated using correlation coefficients. Results All correlations between the parameters of asymmetry and SRS-22 self-image score were of weak strength. Similarly, all correlations between the parameters of asymmetry and SRS-22 mental health score were of weak strength. Conclusion The SRS-22 mental health and self-image domains correlate poorly with external measures of deformity. This demonstrates that the assessment of mental health and self-image by the SRS-22 has little to do with external torso shape. Whilst the SRS-22 assesses the patient as a whole, it provides little information about objective measures of deformity over which a surgeon has control.
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Affiliation(s)
- James Cheshire
- Institute of Metabolism and Systems Research (IMSR), University of Birmingham, Birmingham, UK
| | - Adrian Gardner
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK.,Department of Anatomy, Institute of Clinical Science, University of Birmingham, Birmingham, UK
| | - Fiona Berryman
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Paul Pynsent
- Department of Anatomy, Institute of Clinical Science, University of Birmingham, Birmingham, UK
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Predictors of shoulder level after spinal fusion in adolescent idiopathic scoliosis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 27:370-380. [DOI: 10.1007/s00586-017-5210-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 06/27/2017] [Indexed: 10/19/2022]
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Liu Z, Hu ZS, Qiu Y, Zhang Z, Zhao ZH, Han X, Zhu ZZ. Role of Clavicle Chest Cage Angle Difference in Predicting Postoperative Shoulder Balance in Lenke 5C Adolescent Idiopathic Scoliosis Patients after Selective Posterior Fusion. Orthop Surg 2017; 9:86-90. [PMID: 28276642 DOI: 10.1111/os.12305] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 11/13/2016] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To evaluate the role of preoperative clavicle chest cage angle difference (CCAD) on postoperative radiographic shoulder imbalance, patient's satisfaction and surgeon's fulfillment in Lenke 5 adolescent idiopathic scoliosis (AIS). CCAD, as a novel radiographic parameter, has proven to be a reliable predictor for postoperative shoulder imbalance in Lenke 1 AIS patients. However, the value of CCAD in predicting shoulder balance has never been evaluated in Lenke 5 AIS patients. METHODS A total of 42 Lenke 5C AIS patients aged from 10 to 18 years old with a minimum 2-year follow-up were enrolled for evaluation. All patients underwent selective posterior spinal instrumentation and fusion using the all segmental pedicle screw technique by the same surgical team. The fusion levels were determined according to the Lenke criteria. Shoulder height difference (SHD) and CCAD were measured on anteroposterior (AP) standing radiographs. The patients' satisfaction and the surgeons' fulfillment were evaluated using a questionnaire. A receiver operative characteristic curve analysis was performed to explore the threshold values of preoperative CCAD in the prediction of the final follow-up radiographic shoulder imbalance, patients' satisfaction and surgeons' fulfillment. RESULTS The average preoperative Cobb angle of the main curve was 46.8° ± 4.8°, and the average immediate postoperative Cobb angle was 13.3° ± 2.6°, representing an average surgical correction rate of 75.6% ± 8.5%. The average follow-up time was 29.2 months. At the last follow-up, the value of preoperative CCAD was significantly higher in patients with unbalanced shoulders (SHD ≥ 10 mm). At the final follow-up, 66.7% (28/42) of the patients were satisfied with their appearance, while 33.3% (14/42) of the patients were not satisfied with their appearance. At the final follow-up, 61.9% (26/42) of the surgeons were fulfilled with their operation, while 38.1% (16/42) of the surgeons were not. For patients' satisfaction and surgeons' fulfillment, the preoperative CCAD was significantly greater in patients with unsatisfied outcomes. DISCUSSION Clavicle chest cage angle difference could be a reliable predictor for evaluating postoperative shoulder imbalance in AIS patients undergoing selective posterior fusion for Lenke 5C curves. A greater preoperative CCAD was significantly correlated with a postoperative radiographic imbalance of shoulders and dissatisfaction, which will guide spine surgeons in their preoperative planning and in the surgical management of AIS to reduce postoperative shoulder imbalance.
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Affiliation(s)
- Zhen Liu
- The Department of Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Zong-Shan Hu
- The Joint Scoliosis Research Center of the Chinese University of Hong Kong & Nanjing University, The Chinese University of Hong Kong, Hong Kong, China
| | - Yong Qiu
- The Department of Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Zhen Zhang
- The Department of Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Zhi-Hui Zhao
- The Department of Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Xiao Han
- The Department of Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Ze-Zhang Zhu
- The Department of Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
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Adrover AM. Answer to the Letter to the Editor of L. P. Ardigò et al. concerning “Validity and reliability of photographic measures to evaluate waistline asymmetry in idiopathic scoliosis” by Matamalas A, Bagó J, D Agata E, Pellisé F (2016) Eur Spine J; 2016 Mar 14 [Epub ahead of print]. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 25:3019-20. [DOI: 10.1007/s00586-016-4689-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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