{"title":"Predicting shoulder balance using novel intraoperative radiographic measures in adolescent idiopathic scoliosis.","authors":"Lane H McCoy, Kirsten Brouillet, Scott J Luhmann","doi":"10.1007/s43390-025-01185-x","DOIUrl":null,"url":null,"abstract":"<p><strong>Study design: </strong>Retrospective case-series OBJECTIVE: The purpose of this study is to validate novel radiographic measures, specifically Rib-2 height (R2H) and T1-Rib-2 Change (T1R2C), as predictors of postoperative shoulder balance following adolescent idiopathic scoliosis (AIS) surgery. Shoulder balance following posterior spinal fusion (PSF) in AIS continues to be important for optimal aesthetic outcomes and patient satisfaction. Using currently accepted radiographic measures intraoperatively (e.g., T1-tilt) for the achievement of shoulder balance remains a challenge. Power analysis determined 28 patients were needed to achieve 80% power with an effect size Pearson's r = 0.5.</p><p><strong>Methods: </strong>AIS patients who underwent PSFs were retrospectively identified when no further deformity correction was completed after the last intraoperative long-cassette radiograph. Traditional radiographic measures were completed. For intra-op patients, a reference vertical was used for all measurements. All measures were Pearson correlated with radiographic shoulder height (RSH) 6 weeks post-op (6wk) and 2y.</p><p><strong>Results: </strong>There were 29 patients (26 female, 90%) whose mean age at surgery was 14.1 years. The mean RSH changed from -14.9mm pre-op to 5.4mm 2y post-op (p =1.9e-6). T1R2C and R2H demonstrated strong positive correlations pre-op (T1R2C r=0.7, p =0.0001) / (R2H r=0.6, p =0.001) to post-op (T1R2C r=0.8, p =2.23e-7) / (R2H r=0.6, p =2e-4). All radiographic variables showed significant correlations with RSH pre-op to post-op (p<0.001). Intraoperative R2H had intermediate associations with RSH at 6wks (r=0.48, p=0.018) and 2y post-op (r=0.4, p =0.04). Intra-op T1R2C and remaining coronal measurements showed no correlation with RSH. Linear regression models show a significant predictive relationship between RSH at 2y and intra-op R2H. The model was not improved when corroborated with intra-op T1R2C.</p><p><strong>Conclusion: </strong>R2H was a significant predictor of RSH pre-op to post-op and intra-op to post-op, performing better than T1R2C and other radiographic measures. R2H could be used as an objective radiographic measurement tool to plan surgery and during surgery to optimize shoulder balance following PSF including T1-Rib-2 Change.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.8000,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Spine deformity","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1007/s43390-025-01185-x","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Study design: Retrospective case-series OBJECTIVE: The purpose of this study is to validate novel radiographic measures, specifically Rib-2 height (R2H) and T1-Rib-2 Change (T1R2C), as predictors of postoperative shoulder balance following adolescent idiopathic scoliosis (AIS) surgery. Shoulder balance following posterior spinal fusion (PSF) in AIS continues to be important for optimal aesthetic outcomes and patient satisfaction. Using currently accepted radiographic measures intraoperatively (e.g., T1-tilt) for the achievement of shoulder balance remains a challenge. Power analysis determined 28 patients were needed to achieve 80% power with an effect size Pearson's r = 0.5.
Methods: AIS patients who underwent PSFs were retrospectively identified when no further deformity correction was completed after the last intraoperative long-cassette radiograph. Traditional radiographic measures were completed. For intra-op patients, a reference vertical was used for all measurements. All measures were Pearson correlated with radiographic shoulder height (RSH) 6 weeks post-op (6wk) and 2y.
Results: There were 29 patients (26 female, 90%) whose mean age at surgery was 14.1 years. The mean RSH changed from -14.9mm pre-op to 5.4mm 2y post-op (p =1.9e-6). T1R2C and R2H demonstrated strong positive correlations pre-op (T1R2C r=0.7, p =0.0001) / (R2H r=0.6, p =0.001) to post-op (T1R2C r=0.8, p =2.23e-7) / (R2H r=0.6, p =2e-4). All radiographic variables showed significant correlations with RSH pre-op to post-op (p<0.001). Intraoperative R2H had intermediate associations with RSH at 6wks (r=0.48, p=0.018) and 2y post-op (r=0.4, p =0.04). Intra-op T1R2C and remaining coronal measurements showed no correlation with RSH. Linear regression models show a significant predictive relationship between RSH at 2y and intra-op R2H. The model was not improved when corroborated with intra-op T1R2C.
Conclusion: R2H was a significant predictor of RSH pre-op to post-op and intra-op to post-op, performing better than T1R2C and other radiographic measures. R2H could be used as an objective radiographic measurement tool to plan surgery and during surgery to optimize shoulder balance following PSF including T1-Rib-2 Change.
研究设计:回顾性病例系列研究目的:本研究的目的是验证新的放射测量,特别是肋骨-2高度(R2H)和t1 -肋骨-2变化(T1R2C),作为青少年特发性脊柱侧凸(AIS)手术后肩部平衡的预测因素。AIS后路脊柱融合术(PSF)后的肩部平衡对于获得最佳美学结果和患者满意度仍然很重要。术中使用目前公认的放射线测量(如t1倾斜)来实现肩部平衡仍然是一个挑战。功效分析确定需要28例患者才能达到80%的功效,效应大小Pearson’s r = 0.5。方法:在最后一次术中长盒x线片后未完成进一步畸形矫正的AIS患者进行PSFs回顾性鉴定。完成了传统的放射线测量。对于术中患者,所有测量均采用参考垂直测量。所有测量结果均与术后6周(6周)和2周的x线肩高(RSH) Pearson相关。结果:29例患者(女性26例,占90%),平均手术年龄14.1岁。平均RSH由术前的-14.9mm变为术后2y的5.4mm (p =1.9e-6)。T1R2C和R2H在术前(T1R2C r=0.7, p =0.0001) / (R2H r=0.6, p =0.001)和术后(T1R2C r=0.8, p =2.23e-7) / (R2H r=0.6, p =2e-4)表现出很强的正相关。结论:R2H是术前至术后、术中至术后RSH的显著预测因子,优于T1R2C及其他影像学指标。R2H可作为一种客观的放射测量工具,用于计划手术,并在手术过程中优化PSF(包括T1-Rib-2 Change)后的肩部平衡。
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.