Is neck tilt and shoulder imbalance the same phenomenon? A prospective analysis of 89 adolescent idiopathic scoliosis patients (Lenke type 1 and 2)

Kwan, Mun Keong; Wong, Kai Ann; Lee, Chee Kean; Chan, Chris Yin Wei

doi:10.1007/s00586-015-4016-9

Cited by 41 publications

(49 citation statements)

References 33 publications

(34 reference statements)

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“…Notably, in our study, T1 tilt was signi cantly improved whereas CHD and Cla-A were not. Kwan advocated that T1 tilt was a parameter associated with neck tilt rather than shoulder balance [17], and our ndings indicated that neck tilt was improved rather shoulder balance in this hypothesis. However, this theory was not supported by other authors.…”

Section: Effect Of Schroth Exercises On Shoulder Balance and Cervicalsupporting

confidence: 50%

Improvement of health-related quality of life and radiographic parameters in adolescent idiopathic scoliosis patients after Schroth exercises

Gao¹,

Li²,

Shao³

et al. 2020

Preprint

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Abstract Background Finding an optimal treatment strategy for adolescent idiopathic scoliosis (AIS) patients remains challenging because of its intrinsic complexity. For mild to moderate scoliosis patients with lower skeletal growth potential (Risser 3–5), most clinicians agree with observation treatment; however, the curve progression that occurs during puberty, the adolescent period, and even in adulthood, remains a challenging issue for clinicians. The aim of study is to investigate the efficacy of Schroth exercise in adolescent idiopathic scoliosis (AIS) patients with lower skeletal growth potential (Risser 3-5) and moderate scoliosis (Cobb angle 20-40°). Methods Data from 43 patients diagnosed with AIS and performed Schroth exercise were reviewed, and outcomes were measured by health-related quality of life (HRQOL) and radiographic parameters. HRQOL was assessed using the visual analog scale (VAS) scores for back, Scoliosis Research Society-22 (SRS-22) patient questionnaire. Radiographic spinopelvic parameters were obtained from anteroposterior and lateral X-rays. The pre-treatment and post-treatment HRQOL and radiographic parameters were tested to validate Schroth exercise efficacy.Results Vas back score, SRS-22 pain and SRS-22 self-image domain domain were significantly improved from pre-treatment 3.0±0.8, 3.6±0.5 and 3.5±0.7 to post-treatment 1.6±0.6, 4.0±0.3 and 3.7±0.4, respectively. No significant improvement of SRS-22 function domain and mental health domain. The mean Cobb angle decreased from 28.9±5.5° to 26.3±5.2° at the final follow-up, despite no statistical significance was observed. The mean C2-C7 sagittal vertical axis (SVA) value decreased from 21.7±8.4 mm to 17.0±8.0mm and mean T1 tilt decreased from 4.9±4.2 ° to 3.5±3.1°. No other significant improvement of radiographic parameters was observed.Conclusions For AIS patients with a Risser 3–5 and a Cobb angle 20°–40°, Schroth exercises improved HRQOL and halted curve progression during the follow-up period. Both cervical spine alignment and shoulder balance were also significantly improved after Schroth exercises. We recommend Schroth exercises for patients with AIS.

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Section: Effect Of Schroth Exercises On Shoulder Balance and Cervicalsupporting

confidence: 50%

Improvement of health-related quality of life and radiographic parameters in adolescent idiopathic scoliosis patients after Schroth exercises

Gao¹,

Li²,

Shao³

et al. 2020

Preprint

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“…Neck and shoulder balance following surgery has been studied and reported by many authors. This imbalance can be divided into lateral or medial shoulder imbalance [ 2 - 4 , 21 - 26 ]. Coracoid height difference, clavicle rib-intersection difference, clavicular angle, and radiological shoulder height contribute to the lateral shoulder imbalance [ 3 , 21 - 25 ].…”

Section: Discussionmentioning

confidence: 99%

“…Coracoid height difference, clavicle rib-intersection difference, clavicular angle, and radiological shoulder height contribute to the lateral shoulder imbalance [ 3 , 21 - 25 ]. T1 tilt, cervical axis, trapezoidal prominence, and neck tilt contribute to the medial shoulder imbalance [ 2 , 4 , 26 ]. The lateral shoulder imbalance can usually be compensated by posture adjustments; however, the medial shoulder imbalance does not respond to posture adjustment and should be resolved during corrective surgery.…”

Section: Discussionmentioning

confidence: 99%

“…However, it had been recognized that in some cases, the unfused compensatory curves above or below the main structural curve are unable to compensate after surgical correction, and “letting go” of the initial curve correction was required to achieve a balanced shoulder and pelvis [ 1 ]. The flexibility of the proximal thoracic (PT) segments plays an important role in determining whether the surgical correction of the main thoracic (MT) curve will lead to neck and shoulder imbalance [ 2 - 4 ]. An imbalanced neck or shoulder after surgery may result in cosmetic dissatisfaction among patients [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

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Cervical Supine Side-Bending versus Cervical Supine Traction Radiographs: Which Is Better in Predicting Proximal Thoracic Flexibility for Lenke 1 and 2 Adolescent Idiopathic Scoliosis?

et al. 2018

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Study DesignProspective cohort study.PurposeThis study compared cervical supine side-bending (CSSB) and cervical supine traction (CST) radiographs to assess the flexibility and predict the correctability of the proximal thoracic (PT) curve for patients with adolescent idiopathic scoliosis (AIS) classified as Lenke 1 and 2.Overview of LiteratureKnowledge of the flexibility of the PT curve is crucial in the management of patients with AIS. There are no reports comparing CSSB and CST radiographs to assess this parameter.MethodsThirty patients with Lenke 1 and 2 AIS scheduled for posterior spinal fusion surgery were recruited. A standing whole spine radiography and physician-supervised CSSB and CST radiographies were performed. Patient demographic and radiological parameters were recorded, including age, gender, weight, height, body mass index, PT angle, main thoracic angle, CSSB PT angle, CST PT angle, and postoperative PT angle. From the data collected, the curve flexibility and curve correction index were calculated and compared.ResultsCSSB had a significantly (p <0.05) smaller PT angle (16.6°±10.4°) in comparison to CST (23.7°±10.7°). CSSB had significantly (p <0.05) greater flexibility (44.2%±19.7%) in comparison to CST (19.5%±18.1%). The CSSB correction index (1.2±0.9) was significantly closer to 1 in comparison to the CST correction index (4.4±5.3). There was no difference (p =0.72) between the CSSB PT angle (16.6°±10.4°) and the postoperative PT angle (16.1°±7.5°). However, the CST PT angle (23.7°±10.7°) was significantly (p <0.05) larger than the postoperative PT angle (16.1°±7.5°).ConclusionsCSSB radiographs were better for demonstrating PT flexibility and more accurately predicted correctability in comparison to the CST radiographs.

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“…Therefore, the cervical balance seems to be independent of the shoulder balance. Kwan also found that the phenomenon of cervical tilt was distinct from that of shoulder imbalance with poor correlation with each other [ 14 , 15 ]. However, to date, the mechanism underlying deteriorated cervical tilt in Lenke type 2 AIS patients without PT curve fully fused has not been investigated.…”

Section: Discussionmentioning

confidence: 99%

Full fusion of proximal thoracic curve helps to prevent postoperative cervical tilt in Lenke type 2 adolescent idiopathic scoliosis patients with right-elevated shoulder

Jiang

Qian

Qiu

et al. 2017

BMC Musculoskelet Disord

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BackgroundTo date, no study had reported the phenomenon of deteriorated postoperative cervical tilt in Lenke type 2 adolescent idiopathic scoliosis patients. The purpose of this study is to evaluate the cervical tilt in Lenke type 2 adolescent idiopathic scoliosis patients with right-elevated shoulder treated by either full fusion or partial/non fusion of the proximal thoracic curve.MethodsA total of 30 Lenke type 2 AIS patients with preoperative right-elevated shoulder underwent posterior spinal instrumentation from 2009 to 2011 were included in this study. All the subjects were divided into 2 groups according to the selection of upper instrumented vertebra. There were 14 cases proximally fused to T1 or T2 (Group A) and 16 cases proximally fused to T3 or below (Group B). Both standing anteroposterior and sagittal X-ray films of the spine obtained preoperatively, one week after the operation, and at a minimum of two-year follow-up were analyzed with respect to the following parameters: cervical tilt, T1 tilt, proximal thoracic Cobb angle, main thoracic Cobb angle, apical vertebral translation of proximal thoracic curve, apical vertebral translation of main thoracic curve, radiographic shoulder height, cervical lordosis, proximal thoracic kyphosis and main thoracic kyphosis.ResultsMost (83.3%) of the patients in these two groups gained satisfactory shoulder balance after surgery. However, the cervical tilt significantly improved in group A (p < 0.001) but deteriorated in group B (p < 0.001). In group A, the decrease of cervical tilt significantly positively correlated with that of T1 tilt (p < 0.001). In group B, the increase of cervical tilt significantly positively correlated with both the increase of T1 tilt (p < 0.001) and the increase of apical vertebral translation of proximal thoracic curve (p < 0.05).ConclusionsLenke type 2 AIS patients with right-elevated shoulder gain improved shoulder but deteriorated cervical tilt after partial/non fusion of proximal thoracic curve. Full fusion of proximal thoracic curve helps to prevent the residual cervical tilt in these patients.

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Is neck tilt and shoulder imbalance the same phenomenon? A prospective analysis of 89 adolescent idiopathic scoliosis patients (Lenke type 1 and 2)

Abstract: In conclusion, neck tilt is distinct from shoulder imbalance. Clinical neck tilt has poor correlation with clinical shoulder imbalance. Clinical neck tilt grading correlated with cervical axis and T1 tilt whereas clinical shoulder grading correlated with CHD, RSH CRID and CA.

Cited by 41 publications

References 33 publications

Improvement of health-related quality of life and radiographic parameters in adolescent idiopathic scoliosis patients after Schroth exercises

Improvement of health-related quality of life and radiographic parameters in adolescent idiopathic scoliosis patients after Schroth exercises

Cervical Supine Side-Bending versus Cervical Supine Traction Radiographs: Which Is Better in Predicting Proximal Thoracic Flexibility for Lenke 1 and 2 Adolescent Idiopathic Scoliosis?

Full fusion of proximal thoracic curve helps to prevent postoperative cervical tilt in Lenke type 2 adolescent idiopathic scoliosis patients with right-elevated shoulder

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