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Predictors of shoulder level after spinal fusion in adolescent idiopathic scoliosis

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Abstract

Background

For patients with adolescent idiopathic scoliosis, shoulder balance influences their treatment satisfaction and psychological well-being. Several parameters are known to affect postoperative shoulder balance, but few prognostic models are as yet available.

Purpose

This study aimed to identify independent predictive factors that can be used to assess preoperatively which patients are at risk of postoperative shoulder elevation, and to build a linear prediction model.

Methods

N = 102 patients with all Lenke types were reviewed radiographically before surgery and 1 year afterward. The outcome measures were coracoid height difference (CHD), clavicular angle (CA), and clavicle–first rib intersection difference (CiRID). Predictive factors commonly used in the literature were investigated using correlation analysis and statistical testing. Significant contributing factors were included in three multiple linear regression models (for CHD, CA, and CiRID).

Results

The mean shoulder level (CHD) significantly changed from a lower left shoulder value of −8.5 mm before surgery to 3.3 mm at the follow-up examination. A high preoperative left shoulder level by CiRID, a large amount of Cobb angle correction of the distal thoracic curve, a low preoperative Cobb angle in the lumbar curve, and a structural proximal thoracic curve proved to be determinants and thus risk factors for left-sided shoulder elevation after surgery. The three models predicting CHD, CA, and CiRID at the follow-up examination included these four risk factors and were significant.

Conclusions

Preoperative variables have the strongest influence on shoulder level after spinal instrumentation. Additionally, extensive correction of the distal thoracic curve can cause elevation of the left shoulder.

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References

  1. Haher TR, Merola A, Zipnick RI, Gorup J, Mannor D, Orchowski J (1995) Meta-analysis of surgical outcome in adolescent idiopathic scoliosis. A 35-year English literature review of 11,000 patients. Spine (Phila Pa 1976) 20(14):1575–1584

    Article  CAS  Google Scholar 

  2. Danielsson AJ, Wiklund I, Pehrsson K, Nachemson AL (2001) Health-related quality of life in patients with adolescent idiopathic scoliosis: a matched follow-up at least 20 years after treatment with brace or surgery. Eur Spine J 10(4):278–288

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Smyrnis PN, Sekouris N, Papadopoulos G (2009) Surgical assessment of the proximal thoracic curve in adolescent idiopathic scoliosis. Eur Spine J 18(4):522–530. doi:10.1007/s00586-009-0902-3

    Article  PubMed  PubMed Central  Google Scholar 

  4. Iwahara T, Imai M, Atsuta Y (1998) Quantification of cosmesis for patients affected by adolescent idiopathic scoliosis. Eur Spine J 7(1):12–15

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Smith PL, Donaldson S, Hedden D, Alman B, Howard A, Stephens D, Wright JG (2006) Parents’ and patients’ perceptions of postoperative appearance in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 31(20):2367–2374. doi:10.1097/01.brs.0000240204.98960.dd

    Article  Google Scholar 

  6. Sanders JO, Polly DW Jr, Cats-Baril W, Jones J, Lenke LG, O’Brien MF, Stephens Richards B, Sucato DJ, AIS Section of the Spinal Deformity Study Group (2003) Analysis of patient and parent assessment of deformity in idiopathic scoliosis using the Walter Reed Visual Assessment Scale. Spine (Phila Pa 1976) 28(18):2158–2163. doi:10.1097/01.BRS.0000084629.97042.0B

    Article  Google Scholar 

  7. Qiu X, Ma W, Li W, Wang B, Yu Y, Zhu Z, Qian B, Zhu F, Sun X, Ng BK (2009) Discrepancy between radiographic shoulder balance and cosmetic shoulder balance in adolescent idiopathic scoliosis patients with double thoracic curve. Eur Spine J 18(1):45–51

    Article  PubMed  Google Scholar 

  8. Kuklo TR, Lenke LG, Graham EJ, Won DS, Sweet FA, Blanke KM, Bridwell KH (2002) Correlation of radiographic, clinical, and patient assessment of shoulder balance following fusion versus nonfusion of the proximal thoracic curve in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 27(18):2013–2020

    Article  Google Scholar 

  9. Lenke LG, Betz RR, Haher TR, Lapp MA, Merola AA, Harms J, Shufflebarger HL (2001) Multisurgeon assessment of surgical decision-making in adolescent idiopathic scoliosis: curve classification, operative approach, and fusion levels. Spine (Phila Pa 1976) 26(21):2347–2353

    Article  CAS  Google Scholar 

  10. King HA, Moe JH, Bradford DS, Winter RB (1983) The selection of fusion levels in thoracic idiopathic scoliosis. J Bone Jt Surg Am 65(9):1302–1313

    Article  CAS  Google Scholar 

  11. Cao K, Watanabe K, Hosogane N, Toyama Y, Yonezawa I, Machida M, Yagi M, Kaneko S, Kawakami N, Tsuji T, Matsumoto M (2014) Association of postoperative shoulder balance with adding-on in Lenke Type II adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 39(12):E705–E712. doi:10.1097/BRS.0000000000000325

    Article  Google Scholar 

  12. Chang DG, Kim JH, Kim SS, Lim DJ, Ha KY, Suk SI (2014) How to improve shoulder balance in the surgical correction of double thoracic adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 39(23):E1359–E1367. doi:10.1097/BRS.0000000000000578

    Article  Google Scholar 

  13. Lenke LG, Bridwell KH, O’Brien MF, Baldus C, Blanke K (1994) Recognition and treatment of the proximal thoracic curve in adolescent idiopathic scoliosis treated with Cotrel-Dubousset instrumentation. Spine (Phila Pa 1976) 19(14):1589–1597

    Article  CAS  Google Scholar 

  14. Lee CK, Denis F, Winter RB, Lonstein JE (1993) Analysis of the upper thoracic curve in surgically treated idiopathic scoliosis. A new concept of the double thoracic curve pattern. Spine (Phila Pa 1976) 18(12):1599–1608

    Article  CAS  Google Scholar 

  15. Yagi M, Takemitsu M, Machida M (2013) Chest cage angle difference and rotation of main thoracic curve are independent risk factors of postoperative shoulder imbalance in surgically treated patients with adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 38(19):E1209–E1215. doi:10.1097/BRS.0b013e31829e0309

    Article  Google Scholar 

  16. Suk SI, Kim WJ, Lee CS, Lee SM, Kim JH, Chung ER, Lee JH (2000) Indications of proximal thoracic curve fusion in thoracic adolescent idiopathic scoliosis: recognition and treatment of double thoracic curve pattern in adolescent idiopathic scoliosis treated with segmental instrumentation. Spine (Phila Pa 1976) 25(18):2342–2349

    Article  CAS  Google Scholar 

  17. Zang L, Fan N, Hai Y, Lu SB, Su QJ, Yang JC, Guan L, Kang N, Meng XL, Liu YZ (2016) Evaluation of the predictors of postoperative aggravation of shoulder imbalance in severe and rigid thoracic or thoracolumbar scoliosis. Eur Spine J 25(10):3353–3365

    Article  PubMed  Google Scholar 

  18. Kuklo TR, Lenke LG, Won DS, Graham EJ, Sweet FA, Betz RR, Bridwell KH, Blanke KM (2001) Spontaneous proximal thoracic curve correction after isolated fusion of the main thoracic curve in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 26(18):1966–1975

    Article  CAS  Google Scholar 

  19. Hong J, Suh S, Modi HN, Yang J, Park S (2013) Analysis of factors that affect shoulder balance after correction surgery in scoliosis: a global analysis of all the curvature types. Eur Spine J 22(6):1273–1285

    Article  PubMed  PubMed Central  Google Scholar 

  20. Lee CS, Chung SS, Shin SK, Park YS, Park SJ, Kang KC (2011) Changes of upper thoracic curve and shoulder balance in thoracic adolescent idiopathic scoliosis treated by anterior selective thoracic fusion using VATS. J Spinal Disord Tech 24(7):462–468. doi:10.1097/BSD.0b013e318204d553

    Article  PubMed  Google Scholar 

  21. Koller H, Meier O, McClung A, Hitzl W, Mayer M, Sucato D (2015) Parameters leading to a successful radiographic outcome following surgical treatment for Lenke 2 curves. Eur Spine J 24(7):1490–1501. doi:10.1007/s00586-015-3772-x

    Article  PubMed  Google Scholar 

  22. Elfiky TA, Samartzis D, Cheung WY, Wong YW, Luk KD, Cheung KM (2011) The proximal thoracic curve in adolescent idiopathic scoliosis: surgical strategy and management outcomes. Global Spine J 1(1):27–36. doi:10.1055/s-0031-1296054

    Article  PubMed  PubMed Central  Google Scholar 

  23. Yong MR, Izatt MT, Adam CJ, Labrom RD, Askin GN (2012) Secondary curve behavior in Lenke type 1C adolescent idiopathic scoliosis after thoracoscopic selective anterior thoracic fusion. Spine (Phila Pa 1976) 37(23):1965–1974. doi:10.1097/BRS.0b013e3182583421

    Article  Google Scholar 

  24. Newton PO, O’Brien MF, Shufflebarger HL, Betz RR, Dickson RA, Harms J (2010) Idiopathic scoliosis. The harms study group treatment guide. Thieme, New York

    Google Scholar 

  25. Perdriolle R, Vidal J (1985) Thoracic idiopathic scoliosis curve evolution and prognosis. Spine (Phila Pa 1976) 10(9):785–791

    Article  CAS  Google Scholar 

  26. Lenke LG, Betz RR, Harms J, Bridwell KH, Clements DH, Lowe TG, Blanke K (2001) Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis. J Bone Jt Surg Am 83-A(8):1169–1181

    Article  Google Scholar 

  27. Elsebaie HB, Dannawi Z, Altaf F, Zaidan A, Al Mukhtar M, Shaw MJ, Gibson A, Noordeen H (2016) Clinically orientated classification incorporating shoulder balance for the surgical treatment of adolescent idiopathic scoliosis. Eur Spine J 25(2):430–437

    Article  CAS  PubMed  Google Scholar 

  28. Hong JY, Suh SW, Yang JH, Park SY, Han JH (2013) Reliability analysis of shoulder balance measures: comparison of the four available methods. Spine (Phila Pa 1976) 38(26):E1684–E1690

    Article  Google Scholar 

  29. Akel I, Pekmezci M, Hayran M, Genc Y, Kocak O, Derman O, Erdogan I, Yazici M (2008) Evaluation of shoulder balance in the normal adolescent population and its correlation with radiological parameters. Eur Spine J 17(3):348–354. doi:10.1007/s00586-007-0546-0

    Article  PubMed  Google Scholar 

  30. Ilharreborde B, Even J, Lefevre Y, Fitoussi F, Presedo A, Souchet P, Pennecot GF, Mazda K (2008) How to determine the upper level of instrumentation in Lenke types 1 and 2 adolescent idiopathic scoliosis: a prospective study of 132 patients. J Pediatr Orthop 28(7):733–739. doi:10.1097/BPO.0b013e318185a36b

    Article  PubMed  Google Scholar 

  31. Luhmann SJ, Sucato DJ, Johnston CE, Richards BS, Karol LA (2016) Radiographic assessment of shoulder position in 619 idiopathic scoliosis patients: can T1 tilt be used as an intraoperative proxy to determine postoperative shoulder balance? J Pediatr Orthop 36(7):691–694

    Article  PubMed  Google Scholar 

  32. Cil A, Pekmezci M, Yazici M, Alanay A, Acaroglu RE, Deviren V, Surat A (2005) The validity of Lenke criteria for defining structural proximal thoracic curves in patients with adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 30(22):2550–2555

    Article  Google Scholar 

  33. Li M, Gu S, Ni J, Fang X, Zhu X, Zhang Z (2009) Shoulder balance after surgery in patients with Lenke Type 2 scoliosis corrected with the segmental pedicle screw technique. J Neurosurg Spine 10(3):214–219

    Article  PubMed  Google Scholar 

  34. Matsumoto M, Watanabe K, Kawakami N, Tsuji T, Uno K, Suzuki T, Ito M, Yanagida H, Minami S, Akazawa T (2014) Postoperative shoulder imbalance in Lenke Type 1A adolescent idiopathic scoliosis and related factors. BMC Musculoskelet Disord. doi:10.1186/1471-2474-15-366

    PubMed  PubMed Central  Google Scholar 

  35. Kwan MK, Chan CY (2016) Is there an optimal upper instrumented vertebra (UIV) tilt angle to prevent post-operative shoulder imbalance and neck tilt in Lenke 1 and 2 adolescent idiopathic scoliosis (AIS) patients? Eur Spine J. doi:10.1007/s00586-016-4529-x

    Google Scholar 

  36. Trobisch PD, Samdani AF, Pahys JM, Cahill PJ (2011) Postoperative trunk shift in Lenke 1 and 2 curves: how common is it? and analysis of risk factors. Eur Spine J 20(7):1137–1140. doi:10.1007/s00586-011-1820-8

    Article  PubMed  PubMed Central  Google Scholar 

  37. Matamalas A, Bagó J, D’Agata E, Pellisé F (2015) Does patient perception of shoulder balance correlate with clinical balance? Eur Spine J 25(11):3560–3567

    Article  PubMed  Google Scholar 

  38. Yang S, Feuchtbaum E, Werner BC, Cho W, Reddi V, Arlet V (2012) Does anterior shoulder balance in adolescent idiopathic scoliosis correlate with posterior shoulder balance clinically and radiographically? Eur Spine J 21(10):1978–1983. doi:10.1007/s00586-012-2434-5

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedics and Tumor Orthopaedics, Muenster University Hospital, Albert-Schweitzer Campus 1, 48149, Muenster, Germany

    Jan Henrik Terheyden, Mark Wetterkamp, Georg Gosheger, Tobias Lange & Albert Schulze Bövingloh

  2. Department of Spine Surgery, St. Franziskus-Hospital, Schönsteinstrasse 63, 50825, Cologne, Germany

    Viola Bullmann

  3. Department of Spine Surgery, St. Franziskus Hospital, Hohenzollernring 72, 48145, Muenster, Germany

    Ulf Liljenqvist

  4. Department of Orthopaedics and Trauma Surgery, St. Josef Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791, Bochum, Germany

    Tobias L. Schulte

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  1. Jan Henrik Terheyden
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Correspondence to Jan Henrik Terheyden.

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Terheyden, J.H., Wetterkamp, M., Gosheger, G. et al. Predictors of shoulder level after spinal fusion in adolescent idiopathic scoliosis. Eur Spine J 27, 370–380 (2018). https://doi.org/10.1007/s00586-017-5210-8

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  • DOI: https://doi.org/10.1007/s00586-017-5210-8

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