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Banno T, Yamato Y, Hasegawa T, Yoshida G, Arima H, Oe S, Ide K, Yamada T, Kurosu K, Matsuyama Y. Evaluation of the changes in waistline asymmetry using digital photography in adolescents with idiopathic thoracolumbar/lumbar scoliosis after corrective surgery. Spine Deform 2024; 12:1079-1088. [PMID: 38526692 DOI: 10.1007/s43390-024-00850-x] [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: 11/12/2023] [Accepted: 02/18/2024] [Indexed: 03/27/2024]
Abstract
PURPOSE Waist line asymmetry is a major cosmetic concern in patients with adolescent idiopathic scoliosis (AIS). The primary surgical goal in patients with AIS is to correct spinal deformities and prevent further progression while maintaining global alignment. Additionally, an important objective of surgical treatment is to address physical appearance by reducing asymmetry. This study aimed to evaluate changes in waistline asymmetry using digital photographs in adolescents with thoracolumbar/lumbar (TL/L) scoliosis who underwent corrective surgery. METHODS We retrospectively analyzed the data of patients with Lenke types 5C and 6C AIS who underwent posterior fusion surgery with at least 2 years of follow-up. Waist line asymmetry was assessed using digital photography. The waist angle ratio (WAR), waist height angle (WHA), and waistline depth ratio (WLDR) were measured pre- and postoperatively. Radiographic parameters and the revised 22-item Scoliosis Research Society Questionnaire (SRS-22r) were also evaluated. RESULTS Forty-two patients (40 females and 2 males; 34 with type 5C and 8 with type 6C) were included in the study. The WAR, WHA, and WLDR significantly improved after surgery (0.873 → 0.977, - 2.0° → 1.4°, and 0.321 → 0.899, respectively). Every waistline parameter moderately correlated with the apical vertebral translation of the TL/L curve (WAR: r = - 0.398, WHA: r = - 0.442, and WLDR: r = - 0.692), whereas no correlations were observed with the TL/L curve magnitude. No correlations were observed between the photographic parameters and SRS-22r scores. CONCLUSION Lateral displacement of the apical vertebra on the TL/L curve correlated with waistline asymmetry. Preoperative waistline asymmetry improved with scoliosis correction. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
- Tomohiro Banno
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, Shizuoka, 431-3192, Japan.
- Division of Surgical Care, Morimachi, Hamamatsu University School of Medicine, Hamamatsu City, Shizuoka, Japan.
| | - Yu Yamato
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Tomohiko Hasegawa
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, Shizuoka, 431-3192, Japan
- Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu City, Shizuoka, Japan
| | - Go Yoshida
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Hideyuki Arima
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Shin Oe
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, Shizuoka, 431-3192, Japan
- Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu City, Shizuoka, Japan
| | - Koichiro Ide
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Tomohiro Yamada
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Kenta Kurosu
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Yukihiro Matsuyama
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, Shizuoka, 431-3192, Japan
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Moorthy V, Goh GS, Guo CM, Tan SB, Chen JLT, Soh RCC. Risk Factors of Postoperative Shoulder Imbalance in Adolescent Idiopathic Scoliosis: The Role of Sagittal Spinopelvic Parameters and Upper Instrumented Vertebrae Selection. Clin Spine Surg 2022; 35:E137-E142. [PMID: 33657026 DOI: 10.1097/bsd.0000000000001153] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 11/07/2020] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This is a retrospective study. OBJECTIVE To determine (1) the independent risk factors of postoperative shoulder imbalance (PSI) after adolescent idiopathic scoliosis (AIS) correction surgery; and (2) whether the level of upper instrumented vertebrae (UIV) affects postoperative shoulder balance. SUMMARY OF BACKGROUND DATA PSI is an important outcome of AIS correction surgery as it influences a patient's appearance and satisfaction. However, risk factors for PSI remain controversial and there are currently no studies evaluating the effect of sagittal spinopelvic parameters on PSI. Previous studies on the relationship between the level of UIV and PSI have also reported conflicting results. MATERIALS AND METHODS Sixty-nine AIS patients undergoing correction surgery at a single institution were retrospectively reviewed. Radiographic parameters were measured on anteroposterior and lateral x-rays preoperatively, immediate postoperatively, and 12 months postoperatively. At 1 year follow-up, patients were divided into 2 groups based on their radiographic shoulder height (RSH): (1) PSI group (RSH ≥20 mm) and (2) non-PSI group (RSH <20 mm). RESULTS On multivariate regression analysis, a lower postoperative main thoracic curve (MTC) [odds ratio (OR): 0.702, 95% confidence interval (CI): 0.519-0.949, P=0.022], greater percentage correction of MTC (OR: 1.526, 95% CI: 1.049-2.220, P=0.027) and higher postoperative sacral slope (OR: 1.364, 95% CI: 1.014-1.834, P=0.040) were identified as independent risk factors of PSI. When preoperative, postoperative, and absolute change in shoulder parameters were compared across the level of UIV, no significant differences were found regardless of the radiographic shoulder parameter analyzed. CONCLUSIONS Lower postoperative MTC, greater percentage correction of MTC and higher postoperative sacral slope were independent risk factors of PSI. Shoulder balance and symmetry were not affected by the level of UIV selected. Relative curve correction is a more important consideration than UIV to avoid PSI after AIS correction surgery. 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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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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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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Hiett A, Tung R, Emanuelli E, Sherman A, Anderson JT, Schwend RM. 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. Spine Deform 2020; 8:1279-1286. [PMID: 32458258 DOI: 10.1007/s43390-020-00147-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 05/19/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE This study sought to analyze factors that predict postoperative shoulder balance based on clinical photography. METHODS Based on inclusion criteria, 132 AIS patients were selected. Age, sex, and BMI of each patient were recorded. The following parameters were recorded from radiographs: clavicle angle, T1 tilt, the upper instrumented vertebra (UIV), lowest instrumented vertebra (LIV) thoracic kyphosis, lumbar modifier, preoperative and postoperative proximal thoracic Cobb angle, preoperative and postoperative main thoracic Cobb angle, and preoperative and postoperative thoracolumbar Cobb angle, if applicable. Two spine surgeons independently assigned the photographs shoulder balance grades based on the WRVAS (1-2 = Acceptable, 3-5 = Unacceptable). Surgeons were blinded as to whether the photographs were taken preoperatively or postoperatively. The shoulders were also graded as right high, left high, or balanced. RESULTS Of all variables analyzed, only main thoracic Cobb angle correction (MTCAC) showed a statistically significant relationship with postoperative shoulder balance (p = 0.01). Odds of having unacceptable shoulder balance increase by 21% for every 5° increase in MTCAC (Adjusted OR = 1.21, 95% CI 1.015-1.452). The odds of unbalanced shoulders are 4.7 times higher for patients whose MTCAC is 40° or more (p = 0.001). Inter-rater reliability was excellent (k =0 .7). Intra rater reliability was perfect for Surgeon 1 (kappa = 1.0) and showed substantial agreement for Surgeon 2 (kappa = 0.8) CONCLUSIONS: Greater correction of main thoracic Cobb angle predicts unacceptable postoperative shoulder balance with 40° of correction signifying a major dichotomy between acceptable and unacceptable.
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Affiliation(s)
- Andy Hiett
- University of Kansas School of Medicine-Wichita, Wichita, KS, USA
| | - Robert Tung
- University of Kansas School of Medicine-Wichita, Wichita, KS, USA
| | - Elisa Emanuelli
- University of Kansas School of Medicine, Kansas City, KS, USA
| | - Ashley Sherman
- Health Services and Outcomes Research, Children's Mercy-Kansas City, Kansas City, MO, USA
| | - John T Anderson
- Division of Spine Surgery, Department of Orthopaedic Surgery, Children's Mercy-Kansas City, University of Missouri-Kansas City School of Medicine, 2401 Gillham Rd. 2nd floor Annex, Kansas City, MO, 64108, USA.
| | - Richard M Schwend
- Division of Spine Surgery, Department of Orthopaedic Surgery, Children's Mercy-Kansas City, University of Missouri-Kansas City School of Medicine, 2401 Gillham Rd. 2nd floor Annex, Kansas City, MO, 64108, USA
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Hadgaonkar S, Shah S, Bhilare P, Kothari A, Shyam A, Sancheti P, Aiyer SN. Clinical and radiological factors associated with postoperative shoulder imbalance and correlation with patient-reported outcomes following scoliosis surgery. J Orthop 2020; 21:465-472. [PMID: 32982102 DOI: 10.1016/j.jor.2020.08.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/28/2020] [Indexed: 11/27/2022] Open
Abstract
Background Shoulder balance (SB) is an important cosmetic concern and is a determinant to assess outcomes following scoliosis surgery. Shoulder imbalance (SI) has been studied predominantly in idiopathic scoliosis with limited literature on other etiologies. Purpose To assess SB following scoliosis surgery and correlate SRS-30 self-image scores with radiological shoulder imbalance SI. Methods A retrospective analysis was performed for 43 patients undergoing scoliosis surgery with a minimum 2-year follow-up. Radiological SI was assessed by the coracoid height difference on whole spine standing radiographs at preoperative, 12-weeks postoperative and 2-year follow-up. The preoperative Cobb angle, postoperative Cobb angle and mean correction were recorded. The upper and lower end vertebrae (UEV/LEV), and instrumented vertebrae (UIV/LIV) were documented. The aetiology of scoliosis and functional outcomes based on the SRS-30 questionnaire were noted. Results There were 19 males and 24 females with a mean age of 14.5 ± 4.7 years. The 12-week postoperative radiographs showed SI in 15 patients and residual SI in 7 patients at 2-year follow-up. SI was seen in four congenital scoliosis with segmentation or mixed anomalies in the proximal thoracic spine. Two idiopathic scoliosis (Lenke type 1 and type 3) showed SI where the UIV was T3 and T2 respectively. The mean preoperative SRS-30 score for patients with SB (N = 9) was 2.5 ± 0.72 and for SI (N = 34) was 3 ± 0.42 without significant difference (p > 0.5). The final mean SRS-30 self-image score for patients with SB was 3.7 ± 0.54 and for patients with SI was 3.7 ± 0.53 without significant difference (p > 0.05). Conclusion Radiological SI assessed by coracoid height difference was not associated with a significant difference in SRS 30 scores preoperatively and at 2 year follow up. SI was seen with congenital scoliosis associated with segmentation and mixed anomalies of the proximal thoracic spine.
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Affiliation(s)
- Shailesh Hadgaonkar
- Department of Spine Surgery, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, India
| | - Shubham Shah
- Department of Spine Surgery, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, India
| | - Pramod Bhilare
- Department of Spine Surgery, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, India
| | - Ajay Kothari
- Department of Spine Surgery, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, India
| | - Ashok Shyam
- Department of Spine Surgery, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, India
| | - Parag Sancheti
- Department of Spine Surgery, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, India
| | - Siddharth N Aiyer
- Department of Spine Surgery, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, India
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A Positive (+ve) Postoperative Upper Instrumented Vertebra Tilt Angle (≥0°) Significantly Increases the Risk of Medial Shoulder and Neck Imbalance in Lenke 1 and 2 Adolescent Idiopathic Scoliosis Patients. Spine (Phila Pa 1976) 2020; 45:E694-E703. [PMID: 32032325 DOI: 10.1097/brs.0000000000003407] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE To investigate the relationship between a +ve postoperative Upper Instrumented Vertebra (UIV) (≥0°) tilt angle and the risk of medial shoulder/neck and lateral shoulder imbalance among Lenke 1 and 2 Adolescent Idiopathic Scoliosis (AIS) patients following Posterior Spinal Fusion. SUMMARY OF BACKGROUND DATA Current UIV selection strategy has poor correlation with postoperative shoulder balance. The relationship between a +ve postoperative UIV tilt angle and the risk of postoperative shoulder and neck imbalance was unknown. METHODS One hundred thirty-six Lenke 1 and 2 AIS patients with minimum 2 years follow-up were recruited. For medial shoulder and neck balance, patients were categorized into positive (+ve) imbalance (≥+4°), balanced, or negative (-ve) imbalance (≤-4°) groups based on T1 tilt angle/Cervical Axis measurement. For lateral shoulder balance, patients were classified into +ve imbalance (≥+3°) balanced, and -ve imbalance (≤-3°) groups based on Clavicle Angle (Cla-A) measurement. Linear regression analysis identified the predictive factors for shoulder/neck imbalance. Logistic regression analysis calculated the odds ratio of shoulder/neck imbalance for patients with +ve postoperative UIV tilt angle. RESULTS Postoperative UIV tilt angle and preoperative T1 tilt angle were predictive of +ve medial shoulder imbalance. Postoperative UIV tilt angle and postoperative PT correction were predictive of +ve neck imbalance. Approximately 51.6% of patients with +ve medial shoulder imbalance had +ve postoperative UIV tilt angle. Patients with +ve postoperative UIV tilt angle had 14.9 times increased odds of developing +ve medial shoulder imbalance and 3.3 times increased odds of developing +ve neck imbalance. Postoperative UIV tilt angle did not predict lateral shoulder imbalance. CONCLUSION Patients with +ve postoperative UIV tilt angle had 14.9 times increased odds of developing +ve medial shoulder imbalance (T1 tilt angle ≥+4°) and 3.3 times increased odds of developing +ve neck imbalance (cervical axis ≥+4°). LEVEL OF EVIDENCE 4.
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Conformity and Changes in the Radiological Neck and Shoulder Balance Parameters Throughout 3-Year Follow-up Period: Do They Remain the Same? Spine (Phila Pa 1976) 2020; 45:E319-E328. [PMID: 31593064 DOI: 10.1097/brs.0000000000003275] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE The primary objective of this study was to assess the conformity of the radiological neck and shoulder balance parameters throughout a follow-up period of more than 2 years. SUMMARY OF BACKGROUND DATA Postoperative shoulder and neck imbalance are undesirable features among Adolescent Idiopathic Scoliosis patients who underwent Posterior Spinal Fusion. There are many clinical and radiological parameters used to assess this clinical outcome. However, we do not know whether these radiological parameters conform throughout the entire follow-up period. METHODS This was a retrospective study done in a single academic institution. Inclusion criteria were patients with scoliosis who underwent posterior instrumented spinal fusion with pedicle screw fixation and attended all scheduled follow-ups for at least 24 months postoperatively. Radiological shoulder parameters were measured from both preoperative antero-posterior and postoperative antero-posterior radiographs. Lateral shoulder parameters were: Radiographic Shoulder Height, Clavicle Angle (Cla-A), Clavicle-Rib Intersection Difference, and Coracoid Height Difference. Medial shoulder and neck parameters were: T1 Tilt and Cervical Axis (CA). RESULTS The radiographs of 50 patients who had surgery done from November 2013 to November 2015 were analyzed. Mean age of this cohort was 16.3 ± 7.0 years. There were 38 (76%) female patients and 12 (24%) male patients. Mean final follow-up was 38.6 ± 5.8 months. When conformity assessment of the radiological parameter using the interclass coefficient correlation was done, we found that all parameters had significant correlation (P < 0.05). T1 tilt (0.78) had good reliability, CA (0.47), Clavicle-Rib Intersection Difference (0.43), and Coracoid Height Difference (0.40) had moderate reliability and Radiographic Shoulder Height (0.22) and Cla-A (0.13) had poor reliability. CONCLUSION All the radiological shoulder and neck balance parameters studied were conformed and suitable to be used to assess the patient postoperatively. Amongst these radiological parameters, T1 tilt followed by CA recorded to be the most reliable parameters over time. LEVEL OF EVIDENCE 4.
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Brooks JT, Bastrom TP, Bartley CE, Lonner BS, Shah SA, Miyanji F, Asghar J, Newton PO, Yaszay B. In Search of the Ever-Elusive Postoperative Shoulder Balance: Is the T2 UIV the Key? Spine Deform 2019; 6:707-711. [PMID: 30348348 DOI: 10.1016/j.jspd.2018.03.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 01/11/2018] [Accepted: 03/12/2018] [Indexed: 10/28/2022]
Abstract
STUDY DESIGN Multicenter review of prospectively collected data. OBJECTIVE The purpose of this study was to evaluate whether a UIV of T2 reliably results in level shoulders postoperatively. SUMMARY OF BACKGROUND DATA Adolescent idiopathic scoliosis (AIS) patients with a risk of a high left shoulder postoperatively are generally recommended to have instrumentation to T2, those with neutral shoulders a T3 UIV, and those with an elevated right shoulder are recommended a UIV of T4 or below in order to achieve postoperative shoulder balance. METHODS A prospective, multicenter AIS database was queried for subjects with minimum two-year follow-up who underwent posterior spinal fusion to correct their main thoracic deformity. Subjects were grouped based on their proximal fusion level. A high shoulder was defined as >1 cm difference on radiographs. RESULTS A total of 626 subjects met inclusion criteria and were divided by UIVs of T2 189, T3 205, and T4 232. Preoperatively, the groups had similar rates of balanced shoulders (T2 47%, T3 49%, T4 45%) and high left shoulders (T2 8.5%, T3 8.8%, and T4 7.3%). Postoperatively, there was a greater percentage of postoperative shoulder imbalance for T2 (45%) and T3 (48%) UIV groups as compared to T4 (34%, p = .008). As expected, the T2 (46%) and T3 (49%) groups had significantly better upper thoracic curve correction as compared to the T4 group (42%, p < .001). CONCLUSIONS The selection of a T4 UIV results in more shoulder balance postoperatively than T2 or T3, regardless of which shoulder was elevated preoperatively. The selection of a T2 UIV does not guarantee postoperative shoulder balance following posterior treatment of main thoracic curves; however, when compared to the more caudal UIV of T4, an improved upper thoracic curve correction can be anticipated. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- Jaysson T Brooks
- Children's of Mississippi, University of Mississippi Medical Center, 2500 N State St, Jackson, MS 39216, USA
| | - Tracey P Bastrom
- Rady Children's Hospital, 7910 Frost Street, San Diego, CA 92123, USA
| | - Carrie E Bartley
- Rady Children's Hospital, 7910 Frost Street, San Diego, CA 92123, USA
| | - Baron S Lonner
- Scoliosis and Spine Associates, 820 2nd Ave, New York, NY 10017, USA
| | - Suken A Shah
- Alfred I. duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE 19803, USA
| | - Firoz Miyanji
- British Columbia Children's Hospital, 4480 Oak St, Vancouver, BC V6H 3N1, Canada
| | - Jahangir Asghar
- Nicklaus Children's Hospital, 3100 SW 62nd Ave, Miami, FL 33155, USA
| | - Peter O Newton
- Rady Children's Hospital, 7910 Frost Street, San Diego, CA 92123, USA
| | - Burt Yaszay
- Rady Children's Hospital, 7910 Frost Street, San Diego, CA 92123, USA.
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Chan CYW, Gani SMA, Lim MY, Chiu CK, Kwan MK. APSS-ASJ Best Clinical Research Award: Is There a Difference between Patients' and Parents' Perception of Physical Appearance in Adolescent Idiopathic Scoliosis? Asian Spine J 2018; 13:216-224. [PMID: 30472823 PMCID: PMC6454293 DOI: 10.31616/asj.2018.0151] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 09/16/2018] [Indexed: 01/22/2023] Open
Abstract
Study Design Prospective study. Purpose To compare patients’ and parents’ perceptions of physical attributes (PAs) of adolescent idiopathic scoliosis (AIS) patients and to report any correlations between their perceptions and Scoliosis Research Society-22r (SRS-22r) scores. Overview of Literature Few studies have looked into the differences between patients’ and parents’ perceptions of their appearance. Methods AIS patient–parent pairs (n=170) were recruited. The patients’ and parents’ perceptions of six PAs were evaluated: waist asymmetry (WA), rib hump (RH), shoulder asymmetry (SA), neck tilt, breast asymmetry (BrA), and chest prominence. These PAs were ranked, and an aggregate PA (Agg-PA) score was derived from a score assigned to the attribute (6 for the most important PA and 1 for the least important). The patients also completed the SRS-22r questionnaire. Results Ninety-nine patients (58.2%) and 71 patients (41.8%) had thoracic and lumbar major curves, respectively. WA was ranked first by 54 patients (31.8%) and 50 parents (29.4%), whereas RH was ranked first by 50 patients (29.4%) and 38 parents (22.4%). The overall Agg-PA scores were similar for patients and parents (p>0.05). However, for thoracic major curves (TMCs) >40°, a significant difference was noted between the Agg-PA scores of patients and parents for SA (3.5±1.6 vs. 4.2±1.6, p=0.041) and BrA (3.0±1.6 vs. 2.2±1.3, p=0.006). For TMCs <40°, a significant difference was found between the Agg-PA scores of patients and parents for WA (3.7±1.6 vs. 4.4±1.5, p=0.050). BrA was negatively correlated with total SRS-22r score. Conclusions There were no significant differences between patients and parents in their ranking of the most important PAs. For TMCs >40°, there were significant differences in the Agg-PA for SA and BrA. Pa¬tients were more concerned about BrA and parents were more concerned about SA. Patients’ perception of the six PAs had weak correlation with SRS-22r scores.
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Affiliation(s)
- Chris Yin Wei Chan
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Siti Mariam Abd Gani
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Min Yuen Lim
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chee Kidd Chiu
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Zhang S, Zhang L, Feng X, Yang H. Incidence and risk factors for postoperative shoulder imbalance in scoliosis: a systematic review and meta-analysis. 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; 27:358-369. [DOI: 10.1007/s00586-017-5289-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/20/2017] [Accepted: 08/27/2017] [Indexed: 01/11/2023]
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