Sinister! The High Pre-op Left Shoulder is Less Likely to Be Radiographically Balanced at 2 Years Post-op

Overview

Journal Spine Deform

Publisher Springer Nature

Date 2020 Nov 17

PMID 33201494

Citations 6

Authors

Joshua T Bram

Nishank Mehta

John M Flynn

Jason B Anari

Keith D Baldwin

Burt Yaszay

Joshua M Pahys

Patrick J Cahill

Affiliations

Soon will be listed here.

Abstract

Purpose: AIS patients consider shoulder balance an important cosmetic outcome after surgery. We examined the impact of preoperative left shoulder elevation (LSE) and choice of upper instrumented vertebra (UIV) on postoperative shoulder imbalance (PostSI).

Methods: This was a retrospective cohort study utilizing a prospective AIS database. Patients had Lenke type 1-4 curves and preoperative shoulder height ≥ 1.0 cm. Patients with preoperative LSE and right shoulder elevation (RSE) were compared. Shoulder height difference < 1 cm was considered 'mild', 1-2 cm was 'moderate', and ≥ 2.0 cm was 'severe'.

Results: 407 patients had ≥ 1.0 cm imbalance preoperatively, with 88 (21.6%) LSE. There were no differences in gender (p = 0.855) or age (p = 0.477). Patients with LSE more frequently had Lenke type 2 curves (43.2% vs 16.3%, p < 0.001), while preoperative RSE averaged 1.9 ± 0.9 cm versus 1.6 ± 0.5 cm for LSE (p < 0.001). Those with LSE more often had severe PostSI at 2 years (30.7% vs 5.0%, p < 0.001), and only 26.1% of patients with severe preoperative LSE corrected to mild. In contrast, most patients with RSE had mild PostSI regardless of initial imbalance. When examining only LSE patients, there was no difference in preoperative SH by final UIV (p = 0.101). Further, UIV choice did not impact the proportion of severely unbalanced patients postoperatively (p = 0.446). A PTC > 34.5° was predictive of PostSI ≥ 2.0 cm for patients with preoperative LSE.

Conclusion: AIS patients with preoperative LSE are less likely to achieve level shoulders postoperatively. Choice of higher UIV did not affect postoperative shoulder imbalance in this cohort. A PTC > 34.5° was predictive of severe PostSI in patients with preoperative LSE.

Level Of Evidence: II.

Citing Articles

The Influence of Relative Curve Correction and Upper Instrumented Vertebra (UIV) Tilt Angle on Post-operative Shoulder Balance Following Posterior Spinal Fusion (PSF) in Lenke Type 1 and 2 Adolescent Idiopathic Scoliosis (AIS) Patients.

Wei Chan C, Hong N, Chandirasegaran S, Chiu C, Kwan M Global Spine J. 2025; :21925682251325171.

PMID: 40020691 PMC: 11871575. DOI: 10.1177/21925682251325171.

Correlation analysis and clinical significance of changes in upper thoracic vertebra tilt and clavicle angle pre- and post-operation.

Jiang Z, Wang H, Cui R, Wang X, Wang Y, Sun M Front Surg. 2024; 11:1264966.

PMID: 38456171 PMC: 10917990. DOI: 10.3389/fsurg.2024.1264966.

Flexibility-tilt agreement best predicts shoulder balance following posterior spine fusion for adolescent idiopathic scoliosis.

LaBarge M, Waddell W, Chanbour H, Stephens B, Martus J, Mencio G Spine Deform. 2023; 12(2):391-401.

PMID: 38123895 DOI: 10.1007/s43390-023-00797-5.

Preoperative left shoulder elevation > 1 cm is predictive of severe postoperative shoulder imbalance in early onset idiopathic scoliosis patients treated with growth-friendly instrumentation.

Li Y, Yang D, Bergman R, Jha S, Casden M, Smith J Spine Deform. 2023; 11(5):1157-1167.

PMID: 37155134 DOI: 10.1007/s43390-023-00696-9.

Shoulder Imbalance in Adolescent Idiopathic Scoliosis: A Systematic Review of the Current State of the Art.

Nikouei F, Ghandhari H, Ameri E, Mokarami F Arch Bone Jt Surg. 2023; 10(12):992-1003.

PMID: 36721654 PMC: 9846726. DOI: 10.22038/ABJS.2022.64282.3086.

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