European Spine Journal

, Volume 27, Issue 2, pp 305–311 | Cite as

The mechanisms underlying the variety of preoperative directionalities of shoulder tilting in adolescent idiopathic scoliosis patients with double thoracic curve

  • Jun Jiang
  • Bang-ping Qian
  • Yong Qiu
  • Bin Wang
  • Yang Yu
  • Ze-zhang Zhu
Original Article



Preoperative directionality of shoulder tilting seems to be independent of the radiographic features of proximal thoracic (PT) curve in adolescent idiopathic scoliosis (AIS) patients. To date, no study had investigated the mechanisms underlying the variety of preoperative directionalities of shoulder tilting in AIS patients. The purpose of this study was to evaluate the differences of radiographic features between Lenke type 2 (double thoracic curve) AIS patients with different preoperative directionalities of shoulder tilting.


A total of 130 Lenke type 2 AIS patients were included in this study and were divided into two groups according to the value of radiographic shoulder height (RSH). There were 78 cases (71 females and 7 males) with RSH less than 0 cm in Group A and 52 cases (44 females and 8 males) with RSH equal to or more than 0 cm in Group B. Preoperative standing anteroposterior X-ray films of the spine were obtained in all these subjects and were analyzed with respect to the following parameters: T1 tilt, PT Cobb angle, main thoracic (MT) Cobb angle, the apical level of PT curve, the apical level of MT curve, and RSH. These parameters were compared between these two groups and the correlations between RSH and the other parameters were analyzed in all of these subjects.


No significant difference was found between these two groups with respect to PT Cobb angle or the apical level of PT curve (P > 0.05). The apical level of MT curve was significantly more proximal in Group A compared with Group B (P < 0.05). The MT Cobb angle was significantly larger in Group A compared with Group B (P < 0.05). Both the T1 tilt and the PT Cobb angle/MT Cobb angle ratio in Group A were significantly smaller than those in Group B (P < 0.05). The RSH was positively associated with T1 tilt, the apical level of MT curve, and the PT Cobb angle/MT Cobb angle ratio, but was negatively associated with MT Cobb angle (P < 0.05).


The directionality of shoulder tilting is diverse in Lenke type 2 AIS patients. The preoperative directionality of shoulder mainly depends on the profile of MT curve rather than that of PT curve. The RSH should be carefully evaluated before making a surgical plan in these patients.


Idiopathic scoliosis Shoulder Double thoracic curve 



The authors would like to acknowledge the supports from the Natural Science Foundation of China (81601867) and the Natural Science Foundation of Jiangsu Province, China (BK20160107).

Compliance with ethical standards

Conflict of interest

The authors declare that there is no conflict of interest.


  1. 1.
    Arlet V, Ouellet JA, Shilt J, Shen FH, Wood K, Chan D, Hicks J, Bersusky E, Reddi V (2009) Subjective evaluation of treatment outcomes of instrumentation with pedicle screws or hybrid constructs in Lenke type 1 and 2 adolescent idiopathic scoliosis: what happens when judges are blinded to the instrumentation? Eur Spine J 18:1927–1935CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Campbell RM Jr, Adcox BM, Smith MD, Simmons JW 3rd, Cofer BR, Inscore SC, Grohman C (2007) The effect of mid-thoracic VEPTR opening wedge thoracostomy on cervical tilt associated with congenital thoracic scoliosis in patients with thoracic insufficiency syndrome. Spine 32:2171–2177CrossRefPubMedGoogle Scholar
  3. 3.
    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 25:430–437CrossRefPubMedGoogle Scholar
  4. 4.
    Ilharreborde B, Even J, Lefevre Y, Fitoussi F, Presedo A, Souchet P, Penneçot 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 28:733–739CrossRefPubMedGoogle Scholar
  5. 5.
    Jiang J, Mao S, Zhao Q, Liu Z, Qian B, Zhu F, Qiu Y (2012) Different proximal thoracic curve patterns have different relative positions of esophagus to spine in adolescent idiopathic scoliosis: a computed tomography study. Spine 37:193–199CrossRefPubMedGoogle Scholar
  6. 6.
    Jiang J, Qian BP, Zhu ZZ, Wang B, Yu Y, Qiu Y (2016) Different potential risk of injury from thoracic pedicle screw insertion between left and right main-stem bronchus in Lenke 1 type adolescent idiopathic scoliosis. Eur Spine J 25:1794–1799CrossRefPubMedGoogle Scholar
  7. 7.
    King HA, Moe JH, Bradford DS, Winter RB (1983) The selection of fusion levels in thoracic idiopathic scoliosis. J Bone Jt Surg (Am) 65:1302–1313CrossRefGoogle Scholar
  8. 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 27:2013–2020CrossRefPubMedGoogle Scholar
  9. 9.
    Kuklo TR, Potter BK, Schroeder TM, O’Brien MF (2006) Comparison of manual and digital measurements in adolescent idiopathic scoliosis. Spine 31:1240–1246CrossRefPubMedGoogle Scholar
  10. 10.
    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(8):1169–1181CrossRefGoogle Scholar
  11. 11.
    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 36:691–694CrossRefPubMedGoogle Scholar
  12. 12.
    Prowse A, Aslaksen B, Kierkegaard M, Furness J, Gerdhem P, Abbott A (2017) Reliability and concurrent validity of postural asymmetry measurement in adolescent idiopathic scoliosis. World J Orthop 8:68–76CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Qiu XS, Ma WW, Li WG, Wang B, Yu Y, Zhu ZZ, Qian BP, Zhu F, Sun X, Ng BK, Cheng JC, Qiu Y (2009) Discrepancy between radiographic shoulder balance and cosmetic shoulder balance in adolescent idiopathic scoliosis patients with double thoracic curve. Eur Spine J 18:45–51CrossRefPubMedGoogle Scholar
  14. 14.
    Rose PS, Lenke LG (2007) Classification of operative adolescent idiopathic scoliosis: treatment guidelines. Orthop Clin N Am 38:521–529CrossRefGoogle Scholar
  15. 15.
    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. Spine 25:2342–2349CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Jun Jiang
    • 1
  • Bang-ping Qian
    • 1
  • Yong Qiu
    • 1
  • Bin Wang
    • 1
  • Yang Yu
    • 1
  • Ze-zhang Zhu
    • 1
  1. 1.The Department of Spine SurgeryThe Affiliated Drum Tower Hospital of Nanjing University Medical SchoolNanjingChina

Personalised recommendations