Tyler C McDonald, Ashley Gnam, Kristin J Weaver, Katie Webb, Eldrin Bhanat, Hamdi Sukkarieh, Patrick B Wright, Jaysson T Brooks
{"title":"Does Obesity Affect Preoperative Shoulder Balance in Adolescent Idiopathic Scoliosis?","authors":"Tyler C McDonald, Ashley Gnam, Kristin J Weaver, Katie Webb, Eldrin Bhanat, Hamdi Sukkarieh, Patrick B Wright, Jaysson T Brooks","doi":"10.1159/000520955","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Obese patients with adolescent idiopathic scoliosis (AIS) have been shown to present with larger curve magnitudes preoperatively. However, the effect of obesity on shoulder balance in AIS remains unknown. The purpose of our study was to determine if overweight and obese patients with AIS have worse radiographic shoulder balance on initial presentation when compared with normal weight patients.</p><p><strong>Methods: </strong>AIS patients <18 years old, with Lenke 1 or 2 curves, who underwent a posterior spinal fusion between March 2013 and December 2018 were retrospectively evaluated. BMI-for-age percentiles as defined by the Center for Disease Control and Prevention were used: obese (≥95th percentile), overweight (85th to <95th percentile), and normal weight (5th to <85th percentile). Shoulder height was measured via the radiographic shoulder height (RSH) method, with an RSH ≤ 1 cm considered balanced. The primary outcome was preoperative shoulder balance. Secondary outcomes included postoperative shoulder balance, major curve correction, and UIV selection.</p><p><strong>Results: </strong>One hundred eighty-four patients (116 [63%] normal weight and 68 [37%] overweight/obese) were included. The mean age at surgery was 13.1 ± 2 years, and mean follow-up was 17.4 ± 13 months. Preoperative shoulder imbalance was significantly greater in the overweight/obese group compared to the normal weight group (1.9 ± 1 cm vs. 1.5 ± 1 cm, p = 0.04). The odds ratio of presenting with unbalanced shoulders was 2.0 (95% CI: 1.02-3.83, p = 0.04) for the overweight/obese group. No significant differences were found for postoperative shoulder balance, UIV selection, or major curve correction.</p><p><strong>Conclusions: </strong>Overweight and obese patients with AIS are twice as likely to present with unbalanced shoulders preoperatively; however, this difference is not clinically relevant with a mean difference of 0.4 cm between cohorts. Finally, the preoperative BMI percentile did not show a significant effect on the chosen UIV or curve magnitude correction.</p><p><strong>Level of evidence: </strong>Level III: this is a retrospective case-control study.</p>","PeriodicalId":54631,"journal":{"name":"Pediatric Neurosurgery","volume":"57 1","pages":"35-39"},"PeriodicalIF":0.9000,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"1","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Pediatric Neurosurgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1159/000520955","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2021/11/16 0:00:00","PubModel":"Epub","JCR":"Q4","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 1
Abstract
Background: Obese patients with adolescent idiopathic scoliosis (AIS) have been shown to present with larger curve magnitudes preoperatively. However, the effect of obesity on shoulder balance in AIS remains unknown. The purpose of our study was to determine if overweight and obese patients with AIS have worse radiographic shoulder balance on initial presentation when compared with normal weight patients.
Methods: AIS patients <18 years old, with Lenke 1 or 2 curves, who underwent a posterior spinal fusion between March 2013 and December 2018 were retrospectively evaluated. BMI-for-age percentiles as defined by the Center for Disease Control and Prevention were used: obese (≥95th percentile), overweight (85th to <95th percentile), and normal weight (5th to <85th percentile). Shoulder height was measured via the radiographic shoulder height (RSH) method, with an RSH ≤ 1 cm considered balanced. The primary outcome was preoperative shoulder balance. Secondary outcomes included postoperative shoulder balance, major curve correction, and UIV selection.
Results: One hundred eighty-four patients (116 [63%] normal weight and 68 [37%] overweight/obese) were included. The mean age at surgery was 13.1 ± 2 years, and mean follow-up was 17.4 ± 13 months. Preoperative shoulder imbalance was significantly greater in the overweight/obese group compared to the normal weight group (1.9 ± 1 cm vs. 1.5 ± 1 cm, p = 0.04). The odds ratio of presenting with unbalanced shoulders was 2.0 (95% CI: 1.02-3.83, p = 0.04) for the overweight/obese group. No significant differences were found for postoperative shoulder balance, UIV selection, or major curve correction.
Conclusions: Overweight and obese patients with AIS are twice as likely to present with unbalanced shoulders preoperatively; however, this difference is not clinically relevant with a mean difference of 0.4 cm between cohorts. Finally, the preoperative BMI percentile did not show a significant effect on the chosen UIV or curve magnitude correction.
Level of evidence: Level III: this is a retrospective case-control study.
研究背景:肥胖青少年特发性脊柱侧凸(AIS)患者术前曲线幅度较大。然而，肥胖对AIS患者肩部平衡的影响尚不清楚。我们研究的目的是确定超重和肥胖的AIS患者与正常体重的患者相比，在初次就诊时肩平衡是否更差。结果:纳入184例患者，其中体重正常116例(63%)，超重/肥胖68例(37%)。平均手术年龄13.1±2岁，平均随访17.4±13个月。术前肩失衡在超重/肥胖组明显大于正常体重组(1.9±1 cm比1.5±1 cm, p = 0.04)。超重/肥胖组出现肩部不平衡的比值比为2.0 (95% CI: 1.02-3.83, p = 0.04)。术后肩部平衡、uv选择或主要曲线矫正方面无显著差异。结论:超重和肥胖AIS患者术前出现肩部不平衡的可能性是其两倍;然而，这一差异不具有临床相关性，队列之间的平均差异为0.4 cm。最后，术前BMI百分位数对选择的uv或曲线幅度校正没有显着影响。证据等级:III级:这是一项回顾性病例对照研究。
期刊介绍：
Articles in ''Pediatric Neurosurgery'' strives to publish new information and observations in pediatric neurosurgery and the allied fields of neurology, neuroradiology and neuropathology as they relate to the etiology of neurologic diseases and the operative care of affected patients. In addition to experimental and clinical studies, the journal presents critical reviews which provide the reader with an update on selected topics as well as case histories and reports on advances in methodology and technique. This thought-provoking focus encourages dissemination of information from neurosurgeons and neuroscientists around the world that will be of interest to clinicians and researchers concerned with pediatric, congenital, and developmental diseases of the nervous system.
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