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The amount of surgical correction of the main thoracic curve is the best predictor of postoperative clinical shoulder balance in patients with Adolescent Idiopathic Scoliosis

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Abstract

Purpose

This study sought to analyze factors that predict postoperative shoulder balance based on clinical photography.

Methods

Based on inclusion criteria, 132 AIS patients were selected. Age, sex, and BMI of each patient were recorded. The following parameters were recorded from radiographs: clavicle angle, T1 tilt, the upper instrumented vertebra (UIV), lowest instrumented vertebra (LIV) thoracic kyphosis, lumbar modifier, preoperative and postoperative proximal thoracic Cobb angle, preoperative and postoperative main thoracic Cobb angle, and preoperative and postoperative thoracolumbar Cobb angle, if applicable. Two spine surgeons independently assigned the photographs shoulder balance grades based on the WRVAS (1–2 = Acceptable, 3–5 = Unacceptable). Surgeons were blinded as to whether the photographs were taken preoperatively or postoperatively. The shoulders were also graded as right high, left high, or balanced.

Results

Of all variables analyzed, only main thoracic Cobb angle correction (MTCAC) showed a statistically significant relationship with postoperative shoulder balance (p = 0.01). Odds of having unacceptable shoulder balance increase by 21% for every 5° increase in MTCAC (Adjusted OR = 1.21, 95% CI 1.015–1.452). The odds of unbalanced shoulders are 4.7 times higher for patients whose MTCAC is 40° or more (p = 0.001). Inter-rater reliability was excellent (k =0 .7). Intra rater reliability was perfect for Surgeon 1 (kappa = 1.0) and showed substantial agreement for Surgeon 2 (kappa = 0.8)

Conclusions

Greater correction of main thoracic Cobb angle predicts unacceptable postoperative shoulder balance with 40° of correction signifying a major dichotomy between acceptable and unacceptable.

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Acknowledgements

We grant permission to reproduce copyrighted materials. Reviewed and approved by the Pediatric IRB at The Children’s Mercy-Kansas City. The authors would like to thank Julia Leamon, MS, RN, CPN for her assistance with the study. 

Funding

No funding was received for the purpose of this study.

Author information

Authors and Affiliations

  1. University of Kansas School of Medicine-Wichita, Wichita, KS, USA

    Andy Hiett & Robert Tung

  2. University of Kansas School of Medicine, Kansas City, KS, USA

    Elisa Emanuelli

  3. Health Services and Outcomes Research, Children’s Mercy-Kansas City, Kansas City, MO, USA

    Ashley Sherman

  4. Division of Spine Surgery, Department of Orthopaedic Surgery, Children’s Mercy-Kansas City, University of Missouri-Kansas City School of Medicine, 2401 Gillham Rd. 2nd floor Annex, Kansas City, MO, 64108, USA

    John T. Anderson & Richard M. Schwend

Authors
  1. Andy Hiett
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  2. Robert Tung
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  3. Elisa Emanuelli
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  4. Ashley Sherman
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  5. John T. Anderson
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Contributions

AH: substantial contributions to the conception or design of the work and acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published. RT: substantial contributions to the conception or design of the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published. EE: substantial contributions to the conception or design of the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published. AS: acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published. JA: substantial contributions to the conception or design of the work and acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published. RS: substantial contributions to the conception or design of the work and acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published.

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Correspondence to John T. Anderson.

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Hiett, A., Tung, R., Emanuelli, E. et al. The amount of surgical correction of the main thoracic curve is the best predictor of postoperative clinical shoulder balance in patients with Adolescent Idiopathic Scoliosis. Spine Deform 8, 1279–1286 (2020). https://doi.org/10.1007/s43390-020-00147-9

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  • DOI: https://doi.org/10.1007/s43390-020-00147-9

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