Flexibility-tilt agreement best predicts shoulder balance following posterior spine fusion for adolescent idiopathic scoliosis.

Autor: LaBarge ME; Department of Orthopedic Surgery, Vanderbilt University Medical Center, 2200 Children's Way, Suite 4202, Nashville, TN, 37232, USA., Waddell WH; Department of Orthopedic Surgery, Vanderbilt University Medical Center, 2200 Children's Way, Suite 4202, Nashville, TN, 37232, USA., Chanbour H; Department of Neurologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA., Stephens BF; Department of Orthopedic Surgery, Vanderbilt University Medical Center, 2200 Children's Way, Suite 4202, Nashville, TN, 37232, USA.; Department of Neurologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA., Martus JE; Department of Orthopedic Surgery, Vanderbilt University Medical Center, 2200 Children's Way, Suite 4202, Nashville, TN, 37232, USA., Mencio GA; Department of Orthopedic Surgery, Vanderbilt University Medical Center, 2200 Children's Way, Suite 4202, Nashville, TN, 37232, USA., Louer CR Jr; Department of Orthopedic Surgery, Vanderbilt University Medical Center, 2200 Children's Way, Suite 4202, Nashville, TN, 37232, USA. craig.louer@vumc.org.
Jazyk: angličtina
Zdroj: Spine deformity [Spine Deform] 2024 Mar; Vol. 12 (2), pp. 391-401. Date of Electronic Publication: 2023 Dec 20.
DOI: 10.1007/s43390-023-00797-5
Abstrakt: Purpose: We propose a novel concept, called flexibility-tilt agreement (FTA), which could be applied intra-operatively to improve shoulder balance following posterior spine fusion for Adolescent Idiopathic Scoliosis (AIS). We retrospectively applied this concept to a cohort with thoracic-only curves, seeking to: (1) evaluate the impact of FTA and other peri-operative variables on post-operative shoulder balance, and (2) evaluate deformity characteristics associated with achieving FTA.
Methods: A single-institution registry was queried for patients undergoing PSF from 2000 to 2017 with main thoracic and double thoracic curves with at least 2-year follow-up. Flexibility was defined as the Cobb angle of the unfused proximal thoracic curve (cephalad to chosen UIV) on pre-operative bender. Tilt refers to post-operative UIV tilt angle. FTA means these values cancel (Flexibility + Tilt = 0 ± 5°). Logistic regression was performed to determine the association between peri-operative variables and shoulder balance.
Results: One hundred and sixty-one patients were included, mean age 13.6 years old, and 47-month mean follow-up. FTA was achieved in 74 (46%) patients and was associated with post-operative (OR = 4.59) and final (OR = 6.98) medial shoulder balance with a threshold of 6° (AUC = 0.77, p = 0.038). FTA was the best predictor of shoulder balance of all tested variables.
Conclusion: Patients that showed flexibility-tilt agreement, or FTA, had vastly increased odds of medial and lateral shoulder balance at a minimum of 2-year follow-up for all thoracic curves. Future studies can evaluate whether applying FTA to determine intra-operative corrective maneuvers prospectively leads to improvements in shoulder balance.
Level of Evidence: Level III-retrospective comparative study.
(© 2023. The Author(s), under exclusive licence to Scoliosis Research Society.)
Databáze: MEDLINE
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