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In Search of the Ever-Elusive Postoperative Shoulder Balance: Is the T2 UIV the Key?

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Abstract

Study Design

Multicenter review of prospectively collected data.

Objective

The purpose of this study was to evaluate whether a UIV of T2 reliably results in level shoulders postoperatively.

Summary of Background Data

Adolescent idiopathic scoliosis (AIS) patients with a risk of a high left shoulder postoperatively are generally recommended to have instrumentation to T2, those with neutral shoulders a T3 UIV, and those with an elevated right shoulder are recommended a UIV of T4 or below in order to achieve postoperative shoulder balance.

Methods

A prospective, multicenter AIS database was queried for subjects with minimum two-year follow-up who underwent posterior spinal fusion to correct their main thoracic deformity. Subjects were grouped based on their proximal fusion level. A high shoulder was defined as >1 cm difference on radiographs.

Results

A total of 626 subjects met inclusion criteria and were divided by UIVs of T2 189, T3 205, and T4 232. Preoperatively, the groups had similar rates of balanced shoulders (T2 47%, T3 49%, T4 45%) and high left shoulders (T2 8.5%, T3 8.8%, and T4 7.3%). Postoperatively, there was a greater percentage of postoperative shoulder imbalance for T2 (45%) and T3 (48%) UIV groups as compared to T4 (34%, p = .008). As expected, the T2 (46%) and T3 (49%) groups had significantly better upper thoracic curve correction as compared to the T4 group (42%, p < .001).

Conclusions

The selection of a T4 UIV results in more shoulder balance postoperatively than T2 or T3, regardless of which shoulder was elevated preoperatively. The selection of a T2 UIV does not guarantee postoperative shoulder balance following posterior treatment of main thoracic curves; however, when compared to the more caudal UIV of T4, an improved upper thoracic curve correction can be anticipated.

Level of Evidence

Level 3.

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Author information

Authors and Affiliations

  1. Children’s of Mississippi, University of Mississippi Medical Center, 2500 N State St, 39216, Jackson, MS, USA

    Jaysson T. Brooks MD

  2. 3030 Children’s Way, Rady Children’s Hospital, San Diego, 7910 Frost Street, Suite 410, 92123, CA, USA

    Tracey P. Bastrom MA, Carrie E. Bartley MA, Peter O. Newton MD & Burt Yaszay MD

  3. Scoliosis and Spine Associates, New York, 820 2nd Ave, 10017, NY, USA

    Baron S. Lonner MD

  4. Alfred I. duPont Hospital for Children, Wilmington, 1600 Rockland Rd, 19803, DE, USA

    Suken A. Shah MD

  5. British Columbia Children’s Hospital, 4480 Oak St, BC V6H 3N1, Vancouver, Canada

    Firoz Miyanji MD

  6. Nicklaus Children’s Hospital, 3100 SW 62nd Ave, 33155, Miami, FL, USA

    Jahangir Asghar MD

Authors
  1. Jaysson T. Brooks MD
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  2. Tracey P. Bastrom MA
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  3. Carrie E. Bartley MA
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  4. Baron S. Lonner MD
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  5. Suken A. Shah MD
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  6. Firoz Miyanji MD
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  7. Jahangir Asghar MD
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  8. Peter O. Newton MD
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  9. Burt Yaszay MD
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Consortia

Harms Study Group

Corresponding author

Correspondence to Burt Yaszay MD.

Additional information

Author disclosures: JTB (grants from OMeGA Foundation, outside the submitted work), TPB (grants from Setting Scoliosis Straight Foundation, during the conduct of the study), CEB (grants from Setting Scoliosis Straight Foundation, during the conduct of the study), BSL (grants from Setting Scoliosis Straight Foundation, during the conduct of the study; grants from Setting Scoliosis Straight Foundation, personal fees from DePuy Synthes Spine, K2M, Paradigm Spine, Spine Search, and Ethicon; nonfinancial support from Spine Deformity journal, grants from John and Marcella Fox Fund Grant, grants from OREF, personal fees from Zimmer Biomet, personal fees from Apifix, outside the submitted work), SAS (grants from Setting Scoliosis Straight Foundation, during the conduct of the study; personal fees from DePuy Synthes Spine and K2M, outside the submitted work), FM (grants from Setting Scoliosis Straight Foundation, during the conduct of the study), JA (grants from Setting Scoliosis Straight Foundation, during the conduct of the study; personal fees and nonfinancial support from Omega innovative Technologies; personal fees from Life Spine and Globus Medical, outside the submitted work), PON (grants from Setting Scoliosis Straight Foundation, during the conduct of the study; grants and other from Setting Scoliosis Straight Foundation, other from Rady Children’s Specialists; grants, personal fees, and nonfinancial support from DePuy Synthes Spine; grants and other from SRS; grants from EOS imaging; personal fees from Thieme Publishing; grants from NuVasive; other from Electrocore; personal fees from Cubist; other from International Pediatric Orthopedic Think Tank; grants, nonfinancial support, and other from Orthopediatrics; grants, personal fees, and nonfinancial support from K2M; grants and nonfinancial support from Alphatech, outside the submitted work; in addition, PON has a patent “Anchoring Systems and Methods for Correcting Spinal Deformities” (8540754) with royalties paid to DePuy Synthes Spine, a patent “Low Profile Spinal Tethering Systems” (8123749) licensed to DePuy Spine, Inc., a patent “Screw Placement Guide” (7981117) licensed to DePuy Spine, Inc., a patent “Compressor for Use in Minimally Invasive Surgery” (7189244) licensed to DePuy Spine, Inc., and a patent “Posterior Spinal Fixation Pending” to K2M), BY (grants from Setting Scoliosis Straight Foundation, during the conduct of the study; grants and personal fees from K2M and DePuy Synthes Spine; personal fees from NuVasive, Medtronic, Orthopediatrics, Stryker, and Globus; grants from Setting Scoliosis Straight Foundation, outside the submitted work; in addition, BY has a patent K2M with royalties paid), the Harms Study Group (grants from DePuy Synthes Spine, during the conduct of the study; grants from K2M, Inc., grants from EOS Imaging, grants from Zimmer Biomet, grants from Medtronic Spine, outside the submitted work).

This study was conducted at Rady Children’s Hospital, San Diego, CA.

IRB approval was obtained for this study.

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Brooks, J.T., Bastrom, T.P., Bartley, C.E. et al. In Search of the Ever-Elusive Postoperative Shoulder Balance: Is the T2 UIV the Key?. Spine Deform 6, 707–711 (2018). https://doi.org/10.1016/j.jspd.2018.03.010

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  • DOI: https://doi.org/10.1016/j.jspd.2018.03.010

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