Rule breakers achieve successful shoulder balance: unraveling the myth of upper instrumented vertebrae selection criteria.

IF 1.6 Q3 CLINICAL NEUROLOGY

Spine deformity Pub Date : 2024-09-20 DOI:10.1007/s43390-024-00961-5

Luke C Drake, Peter W D'Amore, Bailli Fontenot, Tyler A Tetreault, Manaf Younis, Claudia Leonardi, Jaquelyn Valenzuela-Moss, Lindsay M Andras, Michael J Heffernan

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引用次数: 0

Abstract

Purpose: This study compared shoulder balance outcomes in "rule breakers" (RB) vs. "rule followers" (RF) based on commonly utilized upper instrumented vertebrae (UIV) selection guidelines.

Methods: Adolescent idiopathic scoliosis (AIS) patients (Lenke 1-4) who underwent posterior spine fusion (PSF) with minimum 2-year follow-up had radiographic measurement of shoulder balance including first rib angle (FRA), T1 tilt, coracoid process height difference (CPHD), and clavicle angle (CA) at preop, postop, 6-month, 1-year, and 2-year timepoints. Postoperative outcomes were compared between RB and RF groups defined based on the UIV selection guidelines of Rose and Lenke.

Results: Among 88 patients (43 RF, 45 RB), age, gender, preoperative T1 tilt, FRA, CA, and CPHD were not significantly different between groups (p > 0.05). Immediately post-surgery, the RF group had more balanced shoulders (CPHD: 11.6 mm vs. 15.7 mm, p = 0.033; CA: 2.8° vs. 3.6°, p = 0.045; FRA: 3.4° vs. 5.1°, p = 0.009; T1 tilt: 4.7° vs. 6.1°, p = 0.045). At 2 years, no difference was observed between RF vs. RB in CA (2.3 vs. 2.2°, p = 0.857) and CPHD (8.5 vs. 8.1 mm, p = 0.791). FRA and T1 tilt were higher in RB vs. RF (FRA: 4.6 vs. 2.9°, p = 0.002; T1 tilt: 5.6 vs. 3.9, p = 0.008). Shoulder balance (CPHD < 1 cm) was achieved in 73.1% of RB and 69.9% of RF at 2-year follow-up (p = 0.216).

Conclusion: Adherence to commonly accepted UIV selection guidelines did not predict better shoulder balance. The RB group had worse shoulder balance immediately post-surgery, but also improved more over time. These results suggest the need to refine current UIV selection and management.

Level of evidence: III.

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打破常规者成功实现肩关节平衡：揭开上部器械椎体选择标准的神秘面纱。

目的：本研究根据常用的上部器械椎体（UIV）选择指南，比较了 "规则打破者"（RB）与 "规则遵循者"（RF）的肩部平衡结果：青少年特发性脊柱侧凸（AIS）患者（Lenke 1-4）接受了脊柱后路融合术（PSF），随访至少2年，在术前、术后、6个月、1年和2年的时间点进行了肩部平衡的影像学测量，包括第一肋角（FRA）、T1倾斜度、冠突高度差（CPHD）和锁骨角（CA）。根据Rose和Lenke的UIV选择指南，比较了RB组和RF组的术后效果：在 88 位患者中（43 位 RF，45 位 RB），年龄、性别、术前 T1 倾斜、FRA、CA 和 CPHD 在组间无明显差异（P > 0.05）。手术后，RF 组的肩部更平衡（CPHD：11.6 mm vs. 15.7 mm，p = 0.033；CA：2.8° vs. 3.6°，p = 0.045；FRA：3.4° vs. 5.1°，p = 0.009；T1 倾斜：4.7° vs. 6.1°，p = 0.045）。2年后，RF与RB在CA（2.3 vs. 2.2°，p = 0.857）和CPHD（8.5 vs. 8.1 mm，p = 0.791）方面没有差异。RB与RF相比，FRA和T1倾斜度更高（FRA：4.6 vs. 2.9°，p = 0.002；T1倾斜度：5.6 vs. 3.9，p = 0.008）。肩部平衡（CPHD 结论：遵守普遍接受的 UIV 选择指南并不能预示肩部平衡的改善。RB组术后肩部平衡能力较差，但随着时间的推移也会得到改善。这些结果表明有必要改进目前的 UIV 选择和管理：证据等级：III。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Spine deformity

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.