How to Improve Shoulder Balance in the Surgical Correction of Double Thoracic Adolescent Idiopathic Scoliosis

Chang, Dong‐Gune; Kim, Jin-Hyok; Kim, Sung‐Soo; Lim, Dongwook; Ha, Kee-Yong; Suk, Se-Il

doi:10.1097/brs.0000000000000578

Cited by 44 publications

(36 citation statements)

References 19 publications

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“…13 It was also reported that shoulder balance did not sufficiently improve even after applying the direct vertebral rotation method, which means that less MTC correction is needed to achieve better shoulder balance. 2 The results of our study are consistent with the findings of these previous studies.…”

Section: Discussionsupporting

confidence: 93%

A retrospective study to reveal factors associated with postoperative shoulder imbalance in patients with adolescent idiopathic scoliosis with double thoracic curve

Lee¹,

Hwang²,

Lim³

et al. 2016

PED

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OBJECTIVE Postoperative shoulder imbalance (PSI) is a critical consideration after corrective surgery for a double thoracic curve (Lenke Type 2); however, the radiographic factors related to PSI remain unclear. The purpose of this study was to identify the radiographic factors related to PSI after corrective surgery for adolescent idiopathic scoliosis (AIS) in patients with a double thoracic curve. METHODS This study included 80 patients with Lenke Type 2 AIS who underwent corrective surgery. Patients were grouped according to the presence [PSI(+)] or absence [PSI(-)] of shoulder imbalance at the final follow-up examination (differences of 20, 15, and 10 mm were used). Various radiographic parameters, including the Cobb angle of the proximal and middle thoracic curves (PTC and MTC), radiographic shoulder height (RSH), clavicle angle, T-1 tilt, trunk shift, and proximal and distal wedge angles (PWA and DWA), were assessed before and after surgery and compared between groups. RESULTS Overall, postoperative RSH decreased with time in the PSI(-) group but not in the PSI(+) group. Statistical analyses revealed that the preoperative Risser grade (p = 0.048), postoperative PWA (p = 0.028), and postoperative PTC/MTC ratio (p = 0.011) correlated with PSI. Presence of the adding-on phenomenon was also correlated with PSI, although this result was not statistically significant (p = 0.089). CONCLUSIONS Postoperative shoulder imbalance is common after corrective surgery for Lenke Type 2 AIS and correlates with a higher Risser grade, a larger postoperative PWA, and a higher postoperative PTC/MTC ratio. Presence of the distal adding-on phenomenon is associated with an increased PSI trend, although this result was not statistically significant. However, preoperative factors other than the Risser grade that affect the development of PSI were not identified by the study. Additional studies are required to reveal the risk factors for the development of PSI.

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Section: Discussionsupporting

confidence: 93%

A retrospective study to reveal factors associated with postoperative shoulder imbalance in patients with adolescent idiopathic scoliosis with double thoracic curve

Lee¹,

Hwang²,

Lim³

et al. 2016

PED

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“…In addition, posterior instrumented fusion can lead to an abrupt transition from mobile segments to stiff junctional stress areas, extensive dissection of the paraspinal musculature, and resection of those lamina and facet joints that weaken the integrity of the posterior structures above and below the fusion segments. 7,8 It is sufficient to use PVCR with monosegmental or 2-level fixation in children 6 years or younger, that is, before structural changes occur above and below the vertebral bodies resected by PVCR. In children of older age, fusion of more than 2-3 levels above and below the PVCR is usually required because short fusion with PVCR may induce adding-on deformity when the levels are fused with segmental PSF.…”

Section: Discussionmentioning

confidence: 99%

“…Coronal balance (CB), sagittal balance (SB), segmental kyphosis (SK), thoracic kyphosis (TK), and lumbar lordosis (LL) were measured as balance parameters. 4,5,[7][8][9]16,29 The magnitudes of both main and compensatory curves were measured with the Cobb method, using the end vertebrae determined on the preoperative standing radiographs. Coronal balance and SB were measured on standing radiographs; CB was measured as the deviation of the C-7 plumb line from the center sacral vertical line and SB as the distance from the C-7 plumb line to a perpendicular line drawn from the posterosuperior corner of the sacrum.…”

Section: Radiographic Measurementsmentioning

confidence: 99%

Congenital scoliosis treated with posterior vertebral column resection in patients younger than 18 years: longer than 10-year follow-up

Chang

Yang

Lee

et al. 2016

SPI

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OBJECTIVE There have been no reports on the long-term radiographic outcomes of posterior vertebral column resection (PVCR) in patients with congenital scoliosis. The purpose of this study was to evaluate the surgical outcomes and complications after PVCR and its long-term effects on correcting this deformity in children with congenital scoliosis. METHODS The authors retrospectively analyzed the medical records of 45 patients with congenital scoliosis who were younger than 18 years at the time of surgery and who underwent PVCR and fusion with pedicle screw fixation (PSF). The mean age of the patients at the time of surgery was 11.3 years (range 2.4–18.0 years), and the mean length of follow-up was 12.8 years (range 10.1–18.2 years). RESULTS The mean Cobb angle of the main curve was 46.5° before PVCR, 13.7° immediately after PVCR, and 17.6° at the last follow-up. For the compensatory cranial curve, PVCR corrected the preoperative Cobb angle of 21.2° to 9.1° postoperatively and maintained it at 10.9° at the last follow-up. For the compensatory caudal curve, the preoperative Cobb angle of 23.8° improved to 7.7° postoperatively and was 9.8° at the last follow-up. The authors noted 22 complications, and the overall incidence of complications was 48.9%. CONCLUSIONS Posterior vertebral column resection is an effective procedure for managing congenital scoliosis in patients younger than 18 years. Use of PVCR and fusion with PSF for congenital scoliosis achieved rigid fixation and satisfactory deformity correction that was maintained over the long term. However, the authors note that PVCR is a technically demanding procedure and entails risks for major complications and excessive blood loss.

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“…Parameters related to should balance include T1 tilt, rst rib angle (FRA), clavicle angle (CA), trapezial angle (TA), and shoulder height difference (SHD) were also measured. 14,15 T1 tilt was de ned by the angle of the upper end plate of T1 vertebrae and the horizontal line. First rib angle was de ned by the angle of the horizontal line and the tangential line that connects the superior border of the rst ribs.…”

Section: Radiographic Measurementsmentioning

confidence: 99%

Distal Adding On In Lenke 2AR Adolescent Idiopathic Scoliosis:risk Factors Analysis and Clinical Assessment

Dong

Tang

Wang

et al. 2020

Preprint

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Background: Risk factors and clinical outcome associated with distal adding on in Lenke 2AR adolescent idiopathic scoliosis (AIS) are not fully elucidated.Methods: Radiographic data of Lenke 2AR AIS patients treated by posterior pedicle screws in a single institution were retrospectively analyzed. Patients who developed distal adding on were compared with patients who did not. Clinical assessment were carried out by SF-36 and SRS-22 questionnaire. Risk factors of distal adding on were explored by binary logistic regression analysis.Results: A total of 88 patients completed an average of 2.9 (2-12.9) years of follow-up were included. 18 (20.5%) patients met the criterion of distal adding on while the rest of 70 cases did not at follow up.Clinical parameters were comparable before surgery and became lower at follow up in adding on group in dimensions of vitality (63.1±11.4Vs.67.5±11.8,P=0.026), mental health (73.9±9.2Vs.77.8±10.2,P=0.039), self-image (3.9±0.3Vs.4.2±0.3,P=0.021) and satisfaction (4.0±0.3Vs.4.5±0.4,P=0.035). The proportion of selection lowest instrumented vertebra (LIV) higher than last touching vertebra(LTV) was significantly higher in adding on group. (6/18vs 4/70, P=0.004) Binary logistic regression analysis revealed that preoperative main thoracic curve magnitude (OR=1.118,P=0.041), preoperative lumbar lordosis (OR=1.091,P=0.029), and the gap between LIV and LTV(OR=6.123,P=0.043) were independent risk factors associated with adding on.Conclusions: In Lenke 2AR AIS cases, the selection of LIV higher than LTV is closely correlated with the development of adding-on. Patients with minor main thoracic curve and lumbar lordosis are more likely to develop distal adding on. Adding on may cause discontent of patients .

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How to Improve Shoulder Balance in the Surgical Correction of Double Thoracic Adolescent Idiopathic Scoliosis

Abstract: 3.

Cited by 44 publications

References 19 publications

A retrospective study to reveal factors associated with postoperative shoulder imbalance in patients with adolescent idiopathic scoliosis with double thoracic curve

A retrospective study to reveal factors associated with postoperative shoulder imbalance in patients with adolescent idiopathic scoliosis with double thoracic curve

Congenital scoliosis treated with posterior vertebral column resection in patients younger than 18 years: longer than 10-year follow-up

Distal Adding On In Lenke 2AR Adolescent Idiopathic Scoliosis:risk Factors Analysis and Clinical Assessment

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How to Improve Shoulder Balance in the Surgical Correction of Double Thoracic Adolescent Idiopathic Scoliosis

Abstract: 3.

Cited by 44 publications

References 19 publications

A retrospective study to reveal factors associated with postoperative shoulder imbalance in patients with adolescent idiopathic scoliosis with double thoracic curve

A retrospective study to reveal factors associated with postoperative shoulder imbalance in patients with adolescent idiopathic scoliosis with double thoracic curve

Congenital scoliosis treated with posterior vertebral column resection in patients younger than 18 years: longer than 10-year follow-up

Distal Adding On In Lenke 2AR Adolescent Idiopathic Scoliosis:risk Factors&nbsp;Analysis and Clinical Assessment

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Distal Adding On In Lenke 2AR Adolescent Idiopathic Scoliosis:risk Factors Analysis and Clinical Assessment