Jaysson T Brooks1, Tracey P Bastrom2, Carrie E Bartley2, Baron S Lonner3, Suken A Shah4, Firoz Miyanji5, Jahangir Asghar6, Peter O Newton2, Burt Yaszay7. 1. Children's of Mississippi, University of Mississippi Medical Center, 2500 N State St, Jackson, MS 39216, USA. 2. Rady Children's Hospital, 7910 Frost Street, San Diego, CA 92123, USA. 3. Scoliosis and Spine Associates, 820 2nd Ave, New York, NY 10017, USA. 4. Alfred I. duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE 19803, USA. 5. British Columbia Children's Hospital, 4480 Oak St, Vancouver, BC V6H 3N1, Canada. 6. Nicklaus Children's Hospital, 3100 SW 62nd Ave, Miami, FL 33155, USA. 7. Rady Children's Hospital, 7910 Frost Street, San Diego, CA 92123, USA. Electronic address: byaszay.rady@gmail.com.
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.
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.
Authors: Joshua T Bram; Nishank Mehta; John M Flynn; Jason B Anari; Keith D Baldwin; Burt Yaszay; Joshua M Pahys; Patrick J Cahill Journal: Spine Deform Date: 2020-11-17