Discrepancy between radiographic shoulder balance and cosmetic shoulder balance in adolescent idiopathic scoliosis patients with double thoracic curve

Abstract

Shoulder balance is one of the key components to the body deformity in adolescent idiopathic scoliosis (AIS) patients with double thoracic curve and shoulder cosmesis plays an important role in patients' satisfaction of surgical outcomes. Up to now, only radiographic parameters were used to evaluate the shoulder balance in literatures; no corresponding cosmetic parameters have been developed to evaluate the cosmetic shoulder balance. Meanwhile, we often confronted that perfect radiographic shoulder balance was achieved, but the patients complained about the residual cosmetic deformity. This phenomenon implied that discrepancy may exist between radiographic shoulder balance and cosmetic shoulder balance. The present study was carried out to investigate the correlation between radiographic and clinical cosmetic shoulder balance in AIS patients with double thoracic curve. Thirtyfour AIS patients were recruited for this study. All the patients had a double thoracic curve. Six cosmetic parameters--inner shoulder height (SHi), outer shoulder height (SHo), shoulder area index 1 (SAI1), shoulder area index 2 (SAI2), shoulder angle (a1) and axilla angle (a2) were developed and measured on the standing photographs. Also, seven radiographic parameters--T1 tilting (T1), first rib angle (FRA), clavicle angle (CA), coracoid process height (CPH), clavicle-rib cage intersection (CRCI), first rib-clavicle height (FRCH), trapezius length (TL) were measured on the standing posterior-anterior radiographs. Correlation analysis was made between cosmetic parameters and radiographic parameters. SHi was found to be significantly correlated with T1, FRA, CA, CPH, CRCI (P \ 0.05), among which FRA had the highest correlation coefficient. SHo was found to be significantly correlated with T1, FRA, CA, CPH, CRCI, FRCH (P \ 0.05), among which CRCI had the highest correlation coefficient. However, none of the correlation coefficient was greater than 0.8. The correlation coefficients between radiographic parameters and SAI1, SAI2, a1, a2 were also below 0.8 that were similar with SH. The results indicated that radiographic parameters could only partially reflect the shoulder cosmetic appearances. However, none of the existing parameters can accurately reflect the shoulder cosmetic appearance. As cosmesis is critical important to patients' satisfaction, spine surgeons should pay more attention to the cosmetic shoulder balance rather than radiographic shoulder balance.

Iliac crest orientation and geometry in able-bodied and non-treated adolescent idiopathic scoliosis girls with moderate and severe spinal deformity

“…Mac-Thiong et al [4] found similar relationships in AIS with severe scoliosis. A number of articles relate trunk rotation with the Cobb angle (Goldberg et al [2] and Amendt et al [31]) and shoulder cosmesis (Qiu et al [32]), but none reported any correlation with pelvic geometry. Gum et al [10] found only a suggestive correlation of 0.3259 (p = 0.0736) between the largest Cobb angle and left/right pelvic width ratios for the AIS Lenke 1A1 thoracic sub-group.…”

Does anterior shoulder balance in adolescent idiopathic scoliosis correlate with posterior shoulder balance clinically and radiographically?

“…Factors that contribute to the clinical aspects of shoulder deformity are not thoroughly understood. Attempts to evaluate shoulder balance via radiographic parameters are met with significant challenges due to generally less than moderate correlation between radiographic and clinical parameters [5]. Clinicians often focus on the appearance of the shoulders when viewed posteriorly, although patients may focus on anterior shoulder balance.…”

“…1). Main thoracic Cobb angle, T1 tilt, and FRA were previously described measures by Bago et al and Qiu et al [5,10]. T1 tilt is the angle between the line through the superior endplate of T1 and a horizontal line.…”

“…2). Outer shoulder angle is derived from previously described shoulder angle [5,11], which is the angle between a line drawn through the superior aspect of each acromion and the horizontal line. Inner shoulder angle is defined as the angle between a line drawn through two points on the shoulder at which an initial line that approximates the slope of the distal shoulder intersects the trapezius and the horizontal line.…”

“…Previous studies [5,6] have shown that there is weak correlation between radiographic parameters and posterior clinical shoulder balance (Sh.B), and the principles of deformity correction involve consideration of not only the correction of radiographic measures but also that of clinical appearance. As an example, correction of only radiographic parameters in Lenke 2 curves may lead to a decompensated shoulder imbalance if the clinical appearance is not considered in surgical planning [7][8][9].…”