Abstract
Purpose
Prior research has demonstrated the influence of preoperative shoulder elevation (SE), proximal thoracic curve magnitude, and upper instrumented vertebra (UIV) on shoulder balance after PSF for AIS. Our purpose was to evaluate the impact of these factors on shoulder balance in early onset idiopathic scoliosis (EOIS) patients treated with growth-friendly instrumentation.
Methods
This was a multicenter retrospective review. Children with EOIS treated with dual TGR, MCGR, or VEPTR and minimum 2-year follow-up were identified. Demographics and radiographic/surgical data were collected.
Results
145 patients met inclusion criteria: 74 had right SE (RSE), 49 left SE (LSE), and 22 even shoulders (EVEN) preoperatively. Mean follow-up was 5.3 years (range, 2.0–13.1 years). The LSE group had a larger pre-index mean main thoracic curve (p = 0.021) but no difference was observed between groups at the post-index or most recent timepoints. RSE patients with UIV of T2 were more likely to have balanced shoulders post-index than patients with UIV of T3 or T4 (p = 0.011).
Pre-index radiographic shoulder height (RSH) was predictive of post-index shoulder imbalance ≥ 2 cm in the LSE group (p = 0.007). A ROC curve showed a cut-off of 1.0 cm for RSH. 0/16 LSE patients with pre-index RSH < 1.0 cm had post-index shoulder imbalance ≥ 2 cm compared to 8/28 (29%) patients with pre-index RSH > 1.0 cm (p = 0.006).
Conclusion
Preoperative LSE > 1.0 cm is predictive of shoulder imbalance ≥ 2 cm after insertion of TGR, MCGR, or VEPTR in children with EOIS. In patients with preoperative RSE, UIV of T2 resulted in a higher likelihood of balanced shoulders postoperatively.
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Availability of data and materials
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Code availability
The software application and code used for the statistical analysis are available from the corresponding author on reasonable request.
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Acknowledgments
The Pediatric Spine Study Group includes: Abdullah Saad Abdulfattah Abdullah, Edward Ahn, Behrooz Akbarnia, Harry Akoto, Stephen Albanese, Jason Anari, John Anderson, Richard Anderson, Lindsay Andras, Jennifer Bauer, Laura Bellaire, Randy Betz, Craig Birch, Laurel Blakemore, Oheneba Boachie-Adjei, Chris Bonfield, Daniel Bouton, Felix Brassard, Douglas Brockmeyer, Jaysson Brooks, David Bumpass, Pat Cahill, Olivier Chemaly, Jason Cheung, Kenneth Cheung, Robert Cho, Tyler Christman, Eduardo Colom Beauchamp, Daniel Couture, Haemish Crawford, Alvin Crawford, Benny Dahl, Gokhan Demirkiran, Dennis Devito, Mohammad Diab, Hazem El Sebaie, Ron El-Hawary, John Emans, Mark Erickson, Jorge Fabregas, Frances Farley, David Farrington, Graham Fedorak, Ryan Fitzgerald, Lorena Floccari, Jack Flynn, Peter Gabos, Adrian Gardner, Sumeet Garg, Frank Gerow, Michael Glotzbecker, Jaime Gomez, David Gonda, Tenner Guillaume, Purnendu Gupta, Kyle Halvorson, Kim Hammerberg, Christina Hardesty, Daniel Hedequist, Michael Heffernan, John Heflin, Ilkka Helenius, Jose Herrera, Grant Hogue, Josh Holt, Jason Howard, Michael Timothy Hresko, Steven Hwang, Stephanie Ihnow, Brice Ilharreborde, Kenneth Illingworth, Viral Jain, Andrew Jea, Megan Johnson, Charles Johnston, Morgan Jones, Judson Karlen, Lawrence Karlin, Danielle Katz, Noriaki Kawakami, Brian Kelly, Derek Kelly, Raymond Knapp, Paul Koljonen, Kenny Kwan, Hubert Labelle, Robert Lark, A. Noelle Larson, William Lavelle, Lawrence Lenke, Sean Lew, Ying Li, Craig Louer, Scott Luhmann, Jean-Marc Mac-Thiong, Stuart Mackenzie, Erin MacKintosh, Francesco Mangano, David Marks, Sanchez Marquez, Jonathan Martin, Jeffrey Martus, Antonia Matamalas, Oscar Mayer, Richard McCarthy, Amy McIntosh, Jessica McQuerry, Jwalant Mehta, Lionel Metz, Daniel Miller, Firoz Miyanji, Greg Mundis, Josh Murphy, Robert Murphy, Karen Myung, Susan Nelson, Peter Newton, Matthew Newton Ede, Cynthia Nguyen, Susana Nunez, Matthew Oetgen, Timothy Oswald, Jean Ouellet, Josh Pahys, Kathryn Palomino, Stefan Parent, Alejandro Peiro Garcia, Ferran Pellise, Joseph Perra, Jonathan Phillips, Javier Pizones, Selina Poon, Nigel Price, Norman Ramirez-Lluch, Brandon Ramo, Gregory Redding, Todd Ritzman, LuisRodriguez, Juan Carlos Rodriguez-Olaverri, David Roye, Benjamin Roye, Lisa Saiman, Amer Samdani, Francisco Sanchez Perez-Grueso, James Sanders, Jeffrey Sawyer, Christina Sayama, Michael Schmitz, Jacob Schulz, Richard Schwend, Suken Shah, Jay Shapiro, Harry Shufflebarger, David Skaggs, Kevin Smit, John Smith, Brian Snyder, Paul Sponseller, George Stephen, Joe Stone, Peter Sturm, Hamdi Sukkarieh, Ishaan Swarup, Michal Szczodry, John Thometz, George Thompson, TanakaTomoko, Walter Truong, Raphael Vialle, Michael Vitale, John Vorhies, Eric Wall, Shengru Wang, Bill Warner, Stuart Weinstein, Michelle Welborn, Klane White, David Wrubel, Nan Wu, Kwadwo Yankey, Burt Yaszay, Muharrem Yazici, Terry Jianguo Zhang.
Funding
The study was funded by departmental resources.
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YL: Made substantial contributions to the conception or design of the work; performed analysis and interpretation of data; drafted the work; approved the version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. DY: Drafted the work; approved the version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. RB: Performed acquisition of data; revised the work critically for important intellectual content; approved the version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. SJ: Performed analysis of data; revised the work critically for important intellectual content; approved the version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. MC: Performed analysis of data; revised the work critically for important intellectual content; approved the version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. JTS: Revised the work critically for important intellectual content; approved the version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. MV: Revised the work critically for important intellectual content; approved the version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. MH: Performed analysis and interpretation of data; revised the work critically for important intellectual content; approved the version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Pediatric Spine Study Group: Performed acquisition of data; revised the work critically for important intellectual content; approved the version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
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Dr. Li has received research grants from the Scoliosis Research Society, has received consulting fees from Medtronic, has received support for travel from Zimmer-Biomet, and is the Chair of the Scoliosis Research Society’s Outcomes and Benchmarking Committee. Dr. Smith has received royalties from Globus Medical, has received consulting fees from Wishbone and Zimvie, participates on a Data Safety Monitoring Board or Advisory Board for the Pediatric Spine Study Group, and is a board member of the Pediatric Spine Foundation. Dr. Vitale has received research grants from the Pediatric Orthopaedic Society of North America, Orthopaedic Scientific Research Foundation, Pediatric Spine Foundation, and Setting Scoliosis Straight Foundation; has received royalties from Biomet; has received consulting fees from Stryker, Biomet, and NuVasive; and is a board member of the Pediatric Spine Study Group, Pediatric Orthopaedic Society of North America, International Pediatric Orthopaedic Symposium, and Cure 4 the Kids Foundation. The Pediatric Spine Study Group is supported by the Pediatric Spine Foundation; has received research funding from DePuy Synthes Spine, Medtronic, NuVasive, OrthoPediatrics, and Zimmer Biomet; and has received educational support from ATEC Spine, Children’s Hospital Colorado Orthopedics Institute, DePuy Synthes, Globus Medical, Intermountain Primary Children’s Hospital, Medtronic, nView Medical, NuVasive, OrthoPediatrics, Stryker, and ZimVie. The remaining authors declare that they have no conflicts of interest.
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IRB approval, University of Michigan, HUM 00082789, 1/7/14.
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Li, Y., Yang, D., Bergman, R. et al. Preoperative left shoulder elevation > 1 cm is predictive of severe postoperative shoulder imbalance in early onset idiopathic scoliosis patients treated with growth-friendly instrumentation. Spine Deform 11, 1157–1167 (2023). https://doi.org/10.1007/s43390-023-00696-9
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DOI: https://doi.org/10.1007/s43390-023-00696-9