European Spine Journal

, Volume 27, Issue 2, pp 358–369 | Cite as

Incidence and risk factors for postoperative shoulder imbalance in scoliosis: a systematic review and meta-analysis

  • ShengFei Zhang
  • Liang Zhang
  • XinMin Feng
  • HuiLin Yang
Original Article



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.


Scoliosis Postoperative shoulder imbalance Risk factors Meta-analysis 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.


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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • ShengFei Zhang
    • 1
    • 2
  • Liang Zhang
    • 2
  • XinMin Feng
    • 2
  • HuiLin Yang
    • 1
  1. 1.Department of OrthopedicsThe First Affiliated Hospital of Soochow UniversitySuzhouPeople’s Republic of China
  2. 2.Department of OrthopaedicsNorthern Jiangsu People’s HospitalYangzhouPeople’s Republic of China

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