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Can We Control Lateral Shoulder Balance Through Proximal Thoracic Curve Correction in Lenke Type 2 Adolescent Idiopathic Scoliosis?
Lee, Hyung Rae; Hwang, Chang Ju; Seok, Sang Yun; Gwak, Hyun Wook; Cho, Jae Hwan; Lee, Dong-Ho; Lee, Choon Sung.
Afiliación
  • Lee HR; Department of Orthopedic Surgery, Uijeongbu Eulji Medical Center, Uijeongbusi, Gyeonggido.
  • Hwang CJ; Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine.
  • Seok SY; Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Daejeon, Republic of Korea.
  • Gwak HW; St. Peter's Hospital, Seoul.
  • Cho JH; Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine.
  • Lee DH; Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine.
  • Lee CS; St. Peter's Hospital, Seoul.
J Pediatr Orthop ; 44(1): 28-36, 2024 Jan 01.
Article en En | MEDLINE | ID: mdl-37815292
ABSTRACT

BACKGROUND:

Proximal thoracic curve (PTC) correction has been considered to prevent lateral shoulder imbalance in Lenke Type 2 adolescent idiopathic scoliosis (AIS) patients; however, postoperative shoulder imbalance (PSI) commonly occurs despite these strategies with PTC correction. We investigated the hypothesis that PTC correction would not directly affect PSI in the majority of Lenke type 2 AIS cases. Furthermore, we investigated the risk factors for lateral PSI after corrective surgery.

METHODS:

This study examined the records for AIS patients with Lenke type 2 who underwent corrective surgery and followed up for >2 years. Patients were categorized into PSI (-); radiologic shoulder height (RSH)<15 mm, and PSI (+); RSH≥15 mm. Repeated measures analysis of variance was performed at preoperatively, postoperatively, 1 month, and final follow-up. Postoperative lateral shoulder imbalance was predicted by the identification of univariate analysis and multivariate analysis.

RESULTS:

Among the 151 patients reviewed, 29 (19.2%) showed PSI at final follow-up. Lateral shoulder balance parameters showed different directionalities between PSI (-) and (+) groups at postoperatively, 1 month, and final follow-up ( P <0.01 each). Preoperative PTC, middle thoracic curve (MTC) curve and MTC correction showed strong correlations with the RSH ( P =0.01, 0.03, and 0.04, respectively). However, PTC correction did not show a significant correlation with the RSH. Moreover, only a smaller MTC curve and larger MTC correction rate were related to lateral PSI in multivariate analysis.

CONCLUSIONS:

In Lenke type 2 AIS curves, the MTC curve and its correction predominantly influence lateral shoulder imbalance after corrective surgery, irrespective of the PTC correction extent. Consequently, overemphasizing the correction of the PTC curve may not necessarily lead to an improved lateral shoulder balance. When MTC curve is smaller, surgeons should be more careful for MCT overcorrection leading to a lateral shoulder imbalance. LEVEL OF EVIDENCE Level III.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Escoliosis / Fusión Vertebral / Cifosis Tipo de estudio: Prognostic_studies / Risk_factors_studies Límite: Adolescent / Humans Idioma: En Revista: J Pediatr Orthop Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Escoliosis / Fusión Vertebral / Cifosis Tipo de estudio: Prognostic_studies / Risk_factors_studies Límite: Adolescent / Humans Idioma: En Revista: J Pediatr Orthop Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos