Incidence and risk factors for postoperative shoulder imbalance in scoliosis: a systematic review and meta-analysis
- 244 Downloads
This is the first systematic review and meta-analysis to detect the incidence and risk factors for postoperative shoulder imbalance (PSI) in scoliosis.
A systematic online search was conducted to identify eligible studies. ES, OR and WMD with 95% CI were used to assess the incidence and risk factors associated with PSI.
Twenty-six studies were recruited. The pooled incidence of PSI was 25% (95% CI 20–31%). The incidence in Lenke 1 AIS, Lenke 2 AIS, Lenke 5 AIS and mixed AIS was 20% (9–31%), 26% (15–37%), 31% (17–45%) and 27% (19–35%), respectively. Using RSH ≥10 mm as the criterion of PSI, we found that preoperative LC, postoperative RSH, correction rate of MTC at follow-up were primary risk factors for PSI at follow-up. In the analysis of using RSH ≥20 mm as the criterion of PSI, our results showed that Risser sign, postoperative RSH, correction rate of PTC at follow-up, and LC at follow-up were contributing to PSI. Besides, scoliosis patients with PSI were more likely to suffer from adding-on.
The pooled incidence of PSI in scoliosis was 25%. Risser sign, preoperative LC, postoperative RSH, correction rate of PTC at follow-up, correction rate of MTC at follow-up, and LC at follow-up were risk factors for PSI in patients with scoliosis. Adding-on might be a compensatory mechanism for PSI. It is recommended that (1) sufficient correction of PTC and moderate correction of MTC and LC in the operation should be performed; (2) PSI should be prevented not only for the patients’ postoperative appearance, but also for preventing the adding-on phenomenon.
KeywordsScoliosis Postoperative shoulder imbalance Risk factors Meta-analysis
Compliance with ethical standards
Conflict of interest
The authors declare that they have no competing interests.
- 1.Yang M, Li C, Li Y, Zhao Y, Wei X, Zhang G, Fan J, Ni H, Chen Z, Bai Y, Li M (2015) Application of 3D rapid prototyping technology in posterior corrective surgery for Lenke 1 adolescent idiopathic scoliosis patients. Medicine 94(8):e582. doi: 10.1097/md.0000000000000582 CrossRefPubMedPubMedCentralGoogle Scholar
- 2.Liu Z, Hu ZS, Qiu Y, Zhang Z, Zhao ZH, Han X, Zhu ZZ (2017) Role of clavicle chest cage angle difference in predicting postoperative shoulder balance in Lenke 5C adolescent idiopathic scoliosis patients after selective posterior fusion. Orthop Surg 9(1):86–90. doi: 10.1111/os.12305 CrossRefPubMedGoogle Scholar
- 3.Lee CS, Hwang CJ, Lim EJ, Lee DH, Cho JH (2016) A retrospective study to reveal factors associated with postoperative shoulder imbalance in patients with adolescent idiopathic scoliosis with double thoracic curve. J Neurosurg Pediatr 25(6):744–752. doi: 10.3171/2016.6.peds16162 CrossRefPubMedGoogle Scholar
- 4.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 25(18):2342–2349CrossRefPubMedGoogle Scholar
- 6.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 38(19):E1209–E1215. doi: 10.1097/BRS.0b013e31829e0309 CrossRefPubMedGoogle Scholar
- 7.Han X, Liu Z, Qiu Y, Sha S, Yan H, Jin M, Zhu Z (2016) Clavicle chest cage angle difference: is it a radiographic and clinical predictor of postoperative shoulder imbalance in Lenke I adolescent idiopathic scoliosis? Spine 41(17):1346–1354. doi: 10.1097/brs.0000000000001521 CrossRefPubMedGoogle Scholar
- 8.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 39(12):E705–E712. doi: 10.1097/brs.0000000000000325 CrossRefPubMedGoogle Scholar
- 11.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 CrossRefPubMedGoogle Scholar
- 15.Wang X, Lv G, Wang B, Li J, Lu C, Kang Y, Li Y (2014) Risk factors of postoperative shoulder imbalance after major thoracic curve correction in patients with adolescent idiopathic scoliosis. Chin J Spine Spinal Cord 24(6):487–492Google Scholar
- 16.Sun X, Chen Z, Yang W, Li M (2015) Radiographic assessment of shoulder balance in Lenke type I adolescent idiopathic scoliosis following posterior all pedicle screws instrumentation and fusion. Orthop J China 23(9):779–783Google Scholar
- 18.Bjerke BT, Cheung ZB, Shifflett GD, Iyer S, Derman PB, Cunningham ME (2015) Do current recommendations for upper instrumented vertebra predict shoulder imbalance? An attempted validation of level selection for adolescent idiopathic scoliosis. HSS J 11(3):216–222. doi: 10.1007/s11420-015-9451-y CrossRefPubMedPubMedCentralGoogle Scholar
- 19.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 25(10):3065–3074. doi: 10.1007/s00586-016-4529-x CrossRefPubMedGoogle Scholar
- 21.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. doi: 10.1007/s00586-015-4313-3 CrossRefPubMedGoogle Scholar
- 28.Jiang J, Qiu Y, Qian B, Wang B, Yu Y, Zhu Z (2015) Postoperative shoulder balances of Lenke 2 adolescent idiopathic scoliosis patients with preoperative right-elevated shoulder after selective thoracic fusion. Chin J Bone Jt Surg 1:21–26Google Scholar
- 29.Jiang J, Qian B, Qiu Y, Wang B, Yu Y, Zhu Z (2017) Radiographic factors associated with shoulder imbalance immediately after operation in Lenke type 2 adolescent idiopathic scoliosis patients undergoing non-selective thoracic correction. Chin J Bone Jt 1:5–9Google Scholar
- 30.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(18):2013–2020CrossRefPubMedGoogle Scholar