Shoulder balance in Lenke type 2 adolescent idiopathic scoliosis: Should we fuse to the second thoracic vertebra?

Yang, Huiliang; Im, Gi Hye; Hu, Bowen; Wang, Lei; Zhou, Chunguang; Liu, Limin; Song, Yueming

doi:10.1016/j.clineuro.2017.10.036

Cited by 29 publications

(48 citation statements)

References 38 publications

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“…Clinical shoulder balance was defined as the angle from one acromion to the other as referenced from the horizontal line 25 (Figure 1). T1 tilt was defined as the angle between a line parallel to the upper end plate of T1 and the horizontal line 24 (Figure 2). UIV tilt was defined as the angle between a line parallel to the upper end plate of the upper instrumented vertebra and the horizontal line 12 ( Figure 3).…”

Section: Methodsmentioning

confidence: 99%

“…Alternatively, there is a direct contact between the spine and the ribs, which then loosely connect with the scapula. 24 Lee CS et al 13 have conducted a narrative review in order to assess the problems related to the selection of fusion levels in patients with adolescent idiopathic scoliosis and have found that postoperative shoulder imbalance is one of the major controversial issues facing spine surgeons when planning to correct spine deformities, with a weak correlation between clinical and radiological views. Furthermore, there are no guidelines considering surgical techniques, fusion levels, and other risk factors related to postoperative shoulder imbalance.…”

Section: A B C D E F Gmentioning

confidence: 99%

“…Many UIV selection systems had been proposed by many authors in an attempt to obtain well-balanced shoulders. 21,19,8,24 Nevertheless, all of these UIV selecting systems do not guarantee postoperative well-balanced shoulders. 4 Likewise, leveling the upper thoracic spine does not mean well-balanced shoulders postoperatively.…”

Section: A B C D E F Gmentioning

confidence: 99%

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Shoulder Balance and Scoliosis: The Unresolved Issue

Sorour

Elbanna

Samy

2019

Egyptian Spine Journal

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Background Data: The main indication of surgery in patients with AIS is better function and cosmesis. Shoulder balance should be considered amongst cosmetic parameters that are strongly associated with patient satisfaction after surgery in patients with AIS. Proper correction of the main and proximal thoracic curves in conjunction with horizontalization of upper instrumented vertebra (UIV) is supposed to promote shoulder balance. In other words, better correction of radiological parameters should promote clinical shoulder balance; however, this is not always observed. Purpose: Determining which of the following radiological measures correlate significantly with postoperative clinical shoulder balance: T1 tilt, UIV tilt, clavicle rib intersection angle, and degree of proximal thoracic curve correction. Study Design: Retrospective clinical case cohort study. Patients and Methods: The study included 20 patients of AIS operated for correction by pedicle screw instrumentation. There were 13 females and 7 males. The mean age at the time of surgery was 14±2.4 years with a range from 11 to 18 years. Mean preoperative Cobb angle of the major curve was 76.1±21.7° corrected to a mean postoperative Cobb 28.2±14.2°. Correction percentage of the major curve was 63.1±14.2%. The data obtained from high resolution back view photographs (to assess clinical shoulder balance) and whole spine X-ray films taken within the first year of follow-up period (to assess radiological measures related to shoulder balance) were retrospectively evaluated. Outcome measures: clinical shoulder balance was correlated with 4 radiological parameters, namely, proximal thoracic curve correction percentage, T1 tilt, UIV tilt, and clavicle-rib intersection angle. Measurements were done by Surgimap software version 2.2.12 (Nemaris, Inc.,US, https://www.surgimap.com). Results: A weak positive correlation was found between postoperative shoulder balance and UIV tilt (r)=0.242, P=0.305, and a very weak negative correlation was found between postoperative shoulder balance and proximal thoracic curve correction percentage (r)=-0.027, P=0.910. A moderate positive correlation but statistically nonsignificant was found between postoperative shoulder balance and T1 tilt (r)=0.440, P=0.052, and a statistically significant positive correlation was found between shoulder balance and clavicle rib intersection angle (r)=0.567, P=0.009.

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Section: Methodsmentioning

confidence: 99%

Section: A B C D E F Gmentioning

confidence: 99%

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Shoulder Balance and Scoliosis: The Unresolved Issue

Sorour

Elbanna

Samy

2019

Egyptian Spine Journal

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“…Ono et al [4] предложили выделять медиальный и латеральный компоненты плечевого дисбаланса, при этом медиальная зона надплечий имеет высокую степень зависимости от рентгенологических параметров позвоночника во фронтальной плоскости (Th 1 tilt), в то время как латеральный компонент дисбаланса не имеет значимой корреляции с оцениваемыми параметрами позвоночника. Yang et al [5] пришли к тем же выводам на основе анализа результатов лечения 79 пациентов со сколиозами Lenke 2. Авторы отмечают, что фиксация позвоночника до уровня Th 2 позволяет эффективно контролировать лишь медиальный компонент плечевого баланса, в то время как на латеральный компонент большее влияние оказывают предоперационные параметры плечевого пояса.…”

Section: рисunclassified

“…Однако на удовлетворенность пациентов результатами хирургического лечения при идиопатическом сколиозе, помимо степени коррекции, влияют такие факторы, как величина остаточного реберного горба, общий баланс позвоночного столба и баланс плечевого пояса [1][2][3]. Коррекция реберного горба может быть обеспечена выполнением торакопластики, фронтальный баланс позвоночника контролируется интраоперационной рентгенографией, а прогнозирование и интраоперационная оценка баланса плечевого пояса вызывают значительные трудности [4,5]. При коррекции тяжелой деформации позвоночника асимметрия надплечий возникает у 30 % пациентов в раннем послеоперационном периоде [6].…”

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Risk factors for the development of persistent shoulder imbalance after surgical correction of idiopathic scoliosis

2019

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Objective. To assess risk factors for the imbalance of the shoulder girdle and to identify reproducible X-ray criteria for persistent shoulder imbalance after correction of idiopathic scoliosis. Material and Methods. A total of 94 patients with idiopathic scoliosis were included in the retrospective study. All patients underwent primary posterior correction of the deformity using pedicle screw instrumentation. Radiography of the spine throughout its length was performed before surgery, in the early postoperative and in the long-term (at least 12 months after surgery) periods. The shoulder imbalance was considered clinically significant with radiographic shoulder height difference more than 2 cm. Results. A significant decrease in the magnitude of all curves after surgery and in the long-term period was noted. The magnitude of the proximal curve decreased from 25.38° ± 15.89° to 14.51° ± 8.17° (p < 0.0001) and to 14.29° ± 8.25° (p = 0.24); the main thoracic curve from 59.33° ± 20.76° to 20.096° ± 9.89° (p < 0.0001) and to 20.87° ± 9.48° (p = 0.19); and thoracolumbar curve from 47,20° ± 15,99° to 15.69° ± 8.66° (p < 0.0001) and to 16.98° ± 7.6° (p = 0.01), respectively. The shoulder imbalance was recorded in 27 patients (28.72 %) after surgery and in 13 (13.83 %)-in the long-term period. In these patients, various Lenke types of deformity were presented. A correla-Цель исследования. Оценка факторов риска развития дисбаланса плечевого пояса и выявление воспроизводимого рентгенологического критерия стойкого плечевого дисбаланса после коррекции идиопатического сколиоза. Материал и методы. В ретроспективное исследование включены 94 пациента с идиопатическим сколиозом. Всем пациентам проводили первичную дорсальную коррекцию деформации с использованием транспедикулярных винтовых конструкций. Рентгенографию позвоночника на всем его протяжении выполняли перед операцией, в раннем послеоперационном и в отдаленном (не менее 12 мес. после операции) периодах. Плечевой дисбаланс считали клинически значимым при рентгенологической разнице высоты надплечий более 2 см. tion of the distal adding-on phenomenon with self-correction of the shoulder balance is revealed (r = 0.56; p < 0.005). Persistent shoulder imbalance correlated with presence of a structural proximal thoracic curve (p = 0.041642), residual proximal curve magnitude after surgery (r = 0.22; p = 0.03), and presence of a symptom of double rib hump on radiographs after surgery (r = 0.75; p ≤ 0.005). Conclusion. The most characteristic pattern of persistent shoulder imbalance is the presence of asymmetry in the proximal and main regions of the chest. This sign can be detected by intraoperative lateral radiography of the spine, which will allow the surgeon to take measures to eliminate this phenomenon and reduce the probability of persistent shoulder imbalance development.

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