What are normal radiographic spine and shoulder balance parameters among adolescent patients?

Clement, R. Carter; Anari, Jason B.; Bartley, Carrie E.; Bastrom, Tracey P.; Shah, Ronit; Talwar, Divya; Upasani, Vidyadhar V.

doi:10.1007/s43390-020-00074-9

Cited by 9 publications

(11 citation statements)

References 27 publications

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“…Kuklo et al 21 previously graded the degrees of imbalance as: <1 cm was balanced, 1 to 2 cm slight, 2 to 3 cm moderate, and > 3 cm significant. However, a recent study by Clement et al 22 found that in adolescent patients without spinal pathology, the mean shoulder balance was 0.9 ± 0.7 cm (range, −1.5 to 2.4 cm). In the current study, > 2 cm was used as a cutoff for defining shoulder imbalance.…”

Section: Discussionmentioning

confidence: 94%

“…They are, however, outside the mean ± SD of that reported in adolescents without spinal pathology: coronal balance 1.0 ± 0.7 cm (range, −2.8 to 2.0 cm) and shoulder balance 0.9 ± 0.7 cm (range, −1.5 to 2.4 cm). 22 Fourth, of the 916 patients who had both 2-and 5-year follow-up, there were 9 (0.98%) patients who lacked coronal measurements and 23 (2.5%) patients who lacked shoulder height measurements at 5 years. Although these numbers are small their measurements may impact the degree of change observed from 2-to 5-year follow-up.…”

Section: Discussionmentioning

confidence: 95%

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Radiographic Coronal Imbalance and Shoulder Asymmetry Continue to Improve Between 2 and 5 Years Following Surgery of Adolescent Idiopathic Scoliosis

Hughes

Bastrom²,

Bartley³

et al. 2021

Journal of Pediatric Orthopaedics

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Background: Managing patients with coronal imbalance (CI) and shoulder height asymmetry following scoliosis surgery can be challenging. Little is known about the course of findings over time and whether they improve or persist. The aim was to report the rate of suboptimal radiographic CI or shoulder asymmetry (SA) at 5 years in patients who were already reported to have CI or SA 2 years after surgery for adolescent idiopathic scoliosis (AIS). Methods: An AIS database was reviewed for patients with both 2-and 5-year follow-up after surgery. From this cohort, patients with CI > 2 cm or SA > 2 cm at their 2-year follow-up were identified and reevaluated, using the same parameters, at 5-year follow-up. Results: Of 916 patients, 157 (17%) patients had CI and 69 (8%) patients had SA at 2-year follow-up. At 5 years this improved to 53 (6%) and 11 patients (1%), respectively. Conclusions: Having coronal or shoulder imbalance 2 years after surgery for AIS does not guarantee continued imbalance 5 years after surgery. Most patients demonstrate some improvement in these measures of clinical deformity. Anticipating the potential course following a postoperative coronal balance and shoulder height differences can help surgeons manage and counsel their patients appropriately. Levels of Evidence: Level II-therapeutic.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 95%

Radiographic Coronal Imbalance and Shoulder Asymmetry Continue to Improve Between 2 and 5 Years Following Surgery of Adolescent Idiopathic Scoliosis

Hughes

Bastrom²,

Bartley³

et al. 2021

Journal of Pediatric Orthopaedics

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“…The sagittal offset is larger than the values previously quoted the literature 10 who, using a technique of measurements from a plumb line dropped behind the subject, recorded the sagittal balance (a difference of horizontal distance from the plumb line between that measured at the C7 and S2 vertebral levels) as 19.3 ± 17 mm. More recently however, Clement 9 recorded the sagittal offset in a group of adolescents, aged between 10 and 18 years of age, as between 90 mm of negative offset with the VP posteriorly positioned relative to the sacrum and 61 mm of positive offset with the VP positioned anteriorly to the sacrum. Knowledge of the MCID for the coronal and sagittal offset in a non-scoliotic population is important as it allows comparisons to be made with both AIS and SK populations.…”

Section: Discussionmentioning

confidence: 99%

“…Assessments of the range of normality in the measures of coronal and sagittal offset have been reported in the literature using a number of different measurement techniques [9][10][11][12][13] . The literature suggests that a coronal offset of 0 mm ± 28 mm (mean ± 95% CI) and a sagittal offset of between 90 mm of negative offset (C7 vertebral body or vertebra prominens (VP) posterior to the sacrum) and 61 mm of positive offset (C7 or VP anterior to the sacrum) (± 95% CI) would be accepted as representing a non-pathologic state [9][10][11][12][13] . However, these values are one dimensional, being reported separately from each other.…”

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confidence: 99%

The resting coronal and sagittal stance position of the torso in adolescents with and without spinal deformity

Gardner

Archer

Berryman

et al. 2021

Sci Rep

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The purpose of this work is to identify the resting stance of the torso, defined as the position of the C7 vertebral body relative to the sacrum in a ‘birds eye view’, as the coronal and sagittal offset, in those without spinal deformity, those with pre and post-operative AIS, and those with Scheuermann's kyphosis (SK). Using ISIS2 surface topography, the coronal and sagittal offset were measured in a prospective manner in all groups. With bivariate ellipses, a mean and 95% confidence ellipse of the data was developed. Statistical analyses was performed to examine the distribution of the data from the groups. A graphical representation of the data was developed. There were 829 without spinal deformity, 289 in both the pre and post-operative with AIS and 59 with SK. The results showed that the mean coronal offset for all groups was between 2 and 6 mm and the sagittal offset was 12 and 26 mm. Statistically significance was seen for both measures between the non-scoliotic and both AIS groups, along with the pre-operative AIS coronal offset and post-operative AIS sagittal offset and the SK measures. However, all mean values were within the 95% confidence ellipse for all of the groups. Regardless of the size or type of spinal deformity, the position of the C7 vertebral body and sacrum remain within the 95% confidence ellipse of that seen in those without spinal deformity. This work defines the Minimally Clinically Important Difference for all of the groups.

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“…Table V summarizes the evidence reviewed grouped by Lenke type. The distribution of shoulder balance in the normal population is quite broad, and an "average" person who does not have scoliosis may have a 1-cm difference in shoulder height 51 . There-fore, "absolute" shoulder balance should not be the goal of surgery.…”

Section: Discussionmentioning

confidence: 99%

Evidence Behind Upper Instrumented Vertebra Selection in Adolescent Idiopathic Scoliosis

et al. 2021

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Level selection is often a dilemma in adolescent idiopathic scoliosis (AIS) surgery. The goals of selection of the upper instrumented vertebra (UIV) are to achieve the most optimal proximal balance of the shoulders, minimize any caudal problems due to proximal imbalance, and promote optimal sagittal balance.» Several authors have proposed guidelines for selection of fusion levels in AIS. These guidelines are mostly expert opinions of distinguished surgeons in the field; they are not derived from clinical trials but rather from clinical acumen and many years of experience.» We have systematically reviewed and critically analyzed the literature regarding UIV level selection in AIS surgery.Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSREV/A747).

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What are normal radiographic spine and shoulder balance parameters among adolescent patients?

Cited by 9 publications

References 27 publications

Radiographic Coronal Imbalance and Shoulder Asymmetry Continue to Improve Between 2 and 5 Years Following Surgery of Adolescent Idiopathic Scoliosis

Radiographic Coronal Imbalance and Shoulder Asymmetry Continue to Improve Between 2 and 5 Years Following Surgery of Adolescent Idiopathic Scoliosis

The resting coronal and sagittal stance position of the torso in adolescents with and without spinal deformity

Evidence Behind Upper Instrumented Vertebra Selection in Adolescent Idiopathic Scoliosis

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