Does patient perception of shoulder balance correlate with clinical balance?

Matamalas, Antònia; Bagó, Juan; D’Agata, Elisabetta; Pellisé, Ferràn

doi:10.1007/s00586-015-3971-5

Cited by 21 publications

(11 citation statements)

References 32 publications

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“…The difference in 10 mm in RSH was chosen as it has been described as the minimal threshold for clinically significant difference in shoulder height. 3,19 This analysis confirmed that the present study is adequately powered.…”

Section: Discussionsupporting

confidence: 84%

Shoulder Balance Following Correction Surgery for Adolescent Idiopathic Scoliosis

Moorthy

Goh

Guo

et al. 2021

Clinical Spine Surgery: A Spine Publication

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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 cor-rection of major AIS curves, hook constructs offer better postoperative shoulder symmetry.Level of Evidence: III.

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Section: Discussionsupporting

confidence: 84%

Shoulder Balance Following Correction Surgery for Adolescent Idiopathic Scoliosis

Moorthy

Goh

Guo

et al. 2021

Clinical Spine Surgery: A Spine Publication

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“…Whilst considered a key factor in the perception of trunk deformity in scoliotic patients [ 25 , 27 ], it has recently been suggested that patients’ perceptions of their shoulder deformity do not correspond with clinical measures of shoulder balance. Using clinical photography, Matamalas et al [ 33 ] demonstrated no correlation between clinical measures of shoulder balance and patients’ perceptions of their deformity in non-operated scoliotic patients, calling into question the value of shoulder balance in the overall assessment of trunk deformity. Interestingly in a normal study population, Akel et al [ 34 ] found that 28% had a shoulder imbalance greater than 10 mm.…”

Section: Discussionmentioning

confidence: 99%

Do the SRS-22 self-image and mental health domain scores reflect the degree of asymmetry of the back in adolescent idiopathic scoliosis?

et al. 2017

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BackgroundPatient-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.MethodsA 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.ResultsAll 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.ConclusionThe 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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“…[6][7][8] Surgeons' primary aim had always been correcting the coronal curvature. However, PSI became a concern as patients' perspective on their postoperative appearances including shoulder balance was found to be imperative in determining the cosmetic outcomes of the surgery [8][9][10][11][12][13][14][15][16][17][18][19][20][21]22 The focus of surgical concern was then shifted to achieve a balanced postoperative shoulder instead. Various methods were introduced to circumvent PSI such as upper thoracic spine leveling, upper instrumented vertebra (UIV) level selection, UIV tilt angle, fusion level selection, preoperative shoulder balance, proximal thoracic (PT) correction rate and its extent of correction of main thoracic (MT) curve.…”

Section: Introductionmentioning

confidence: 99%

Patients’ Perception and Satisfaction on Neck and Shoulder Imbalance in Adolescent Idiopathic Scoliosis

Lee

Ch’ng

Wong

et al. 2021

Global Spine Journal

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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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Does patient perception of shoulder balance correlate with clinical balance?

Cited by 21 publications

References 32 publications

Shoulder Balance Following Correction Surgery for Adolescent Idiopathic Scoliosis

Shoulder Balance Following Correction Surgery for Adolescent Idiopathic Scoliosis

Do the SRS-22 self-image and mental health domain scores reflect the degree of asymmetry of the back in adolescent idiopathic scoliosis?

Patients’ Perception and Satisfaction on Neck and Shoulder Imbalance in Adolescent Idiopathic Scoliosis

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