Does levelling of T1 tilt intra-operatively affect post-operative shoulder balance in adolescent idiopathic scoliosis patients?

IF 1.6 Q3 CLINICAL NEUROLOGY
Spine deformity Pub Date : 2024-11-01 Epub Date: 2024-07-09 DOI:10.1007/s43390-024-00922-y
Subaraman Ramchandran, Andrew Pierce, Claire Callan, Taghi Ramzanian, Neil Mohile, Sassan Keshavarzi, Thomas Errico, Stephen George
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引用次数: 0

Abstract

Introduction: Previous studies have shown that T1 tilt is positively correlated with post-operative shoulder balance (SB). The aim of this study was to explore the role of intra-operative T1 tilt, among other shoulder parameters as a potential parameter to predict post-operative SB in adolescent idiopathic scoliosis (AIS) patients.

Methods: A retrospective review of AIS patients with structural thoracic curves with minimum 2 year follow up was conducted from a single tertiary center. Standing pre-operative, 1st erect, 1 year and 2-year follow-up; and intra-operative final prone radiographs were reviewed along with clinical data. Patients were stratified into 2 cohorts: Group A-Final intra-operative T1 tilt ≤5° and Group B-Final intra-operative T1 tilt >5°. These groups were compared for post-operative SB as a whole and separately for patients with baseline right or left shoulder high and if UIV was T2 or T3/T4. Patients with optimal SB (Radiographic shoulder height (RSH) <2 cm) at 2 years were compared to sub-optimal SB (RSH ≥ 2 cm) with respect to multiple SB variables.

Results: 55 patients (mean age 15.1 years-old, 43 F, mean BMI 22, mean thoracic Cobb-49.8°) were included. Based on Lenke curve types, there were 13 patients with type 1A, 10 patients with 1B, 12 patients with 1C, 7 patients with 2A, 4 patients with 2B and 9 patients with type 3C. T1 tilt was significantly correlated with RSH, Clavicle angle difference (CAD), First Rib Angle (FRA), and UIV tilt at first erect, 1-year, and 2-year post-op radiographs (p < 0.05 for all). When comparing groups, A and B, Group A patients showed significantly better restoration of their 2-year SB parameters; RSH (6.8 vs 11.8 mm, p = 0.01), CAD (3.9 vs 9.1 p < 0.001) and T1 tilt (4.7 vs 7.8° p = 0.01). Similar results were found for patients with baseline right shoulder high; RSH (p = 0.04), CAD (p < 0.001) and T1 tilt (p < 0.001) and whether UIV was T2 or T3/T4. Eight patients with sub-optimal SB had worse intra-operative T1 tilt (p = 0.03) compared to 47 patients with optimal SB despite no difference in MT Cobb correction (83.1 vs 79.8%, p = 0.57).

Conclusion: Post-operative T1 tilt correlates with lateral shoulder parameters at first erect, 1 year, and 2-year radiographs. Therefore, T1 tilt can potentially be used as a surrogate to predict post-operative SB. Leveling intra-operative T1 tilt ≤5° is associated with better 2-year post-operative shoulder balance parameters irrespective of whether the UIV was T2 or T3/T4. Patients with sub-optimal SB at 2 years had worse final intra-operative T1 tilt despite similar percent correction of main thoracic curve for all patients.

青少年特发性脊柱侧凸患者术中平整 T1 倾斜是否会影响术后肩部平衡?
导言以往的研究表明,T1倾斜度与术后肩关节平衡(SB)呈正相关。本研究旨在探讨术中 T1 倾角和其他肩部参数在预测青少年特发性脊柱侧弯(AIS)患者术后肩部平衡方面的潜在作用:方法: 在一家三级医疗中心对至少随访 2 年的结构性胸椎弯曲 AIS 患者进行回顾性研究。在回顾术前站立、第一次直立、1年和2年随访以及术中最终俯卧位X光片的同时,还回顾了临床数据。患者被分为两组:A组-术中最终T1倾斜度≤5°,B组-术中最终T1倾斜度>5°。对这两组患者的术后 SB 整体情况进行比较,并对基线右肩高或左肩高及 UIV 为 T2 或 T3/T4 的患者分别进行比较。最佳 SB 患者(射线照相肩高(RSH)结果:共纳入 55 名患者(平均年龄 15.1 岁,43 名女性,平均体重指数 22,平均胸廓 Cobb-49.8°)。根据伦克曲线类型,1A型患者13人,1B型患者10人,1C型患者12人,2A型患者7人,2B型患者4人,3C型患者9人。T1 倾斜与 RSH、锁骨角度差(CAD)、第一肋骨角度(FRA)和术后首次直立、1 年和 2 年拍片时的 UIV 倾斜有明显相关性(P 结论:术后 T1 倾斜与 RSH、锁骨角度差(CAD)、第一肋骨角度(FRA)和 UIV 倾斜有明显相关性:术后 T1 倾斜与首次直立、术后 1 年和 2 年拍片时的肩关节外侧参数相关。因此,T1倾斜可作为预测术后SB的替代指标。无论 UIV 是 T2 还是 T3/T4,术中 T1 倾斜≤5°与术后 2 年较好的肩关节平衡参数相关。尽管所有患者的主胸廓曲线矫正百分比相似,但2年后SB不达标的患者的最终术中T1倾斜度更差。
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来源期刊
CiteScore
3.20
自引率
18.80%
发文量
167
期刊介绍: Spine Deformity the official journal of the?Scoliosis Research Society is a peer-refereed publication to disseminate knowledge on basic science and clinical research into the?etiology?biomechanics?treatment?methods and outcomes of all types of?spinal deformities. The international members of the Editorial Board provide a worldwide perspective for the journal's area of interest.The?journal?will enhance the mission of the Society which is to foster the optimal care of all patients with?spine?deformities worldwide. Articles published in?Spine Deformity?are Medline indexed in PubMed.? The journal publishes original articles in the form of clinical and basic research. Spine Deformity will only publish studies that have institutional review board (IRB) or similar ethics committee approval for human and animal studies and have strictly observed these guidelines. The minimum follow-up period for follow-up clinical studies is 24 months.
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