• Eur Spine J · Sep 2018

    Fulcrum flexibility of the main curve predicts postoperative shoulder imbalance in selective thoracic fusion of adolescent idiopathic scoliosis.

    • Soren Ohrt-Nissen, Kamath Vijay H D VHD Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, SAR, China., Dino Samartzis, Luk Keith Dip Kei KDK Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, SAR, China., and Cheung Jason Pui Yin JPY 0000-0002-7052-0875 Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, SAR, China. cheungjp.
    • Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, SAR, China.
    • Eur Spine J. 2018 Sep 1; 27 (9): 2251-2261.

    PurposeTo identify preoperative predictors for postoperative shoulder imbalance (PSI) after corrective surgery of adolescent idiopathic scoliosis (AIS) and using the fulcrum-bending radiograph to assess flexibility.MethodsA consecutive surgical cohort of AIS patients undergoing selective thoracic fusion with alternate-level pedicle screw fixation was prospectively studied. Preoperative anteroposterior, lateral and fulcrum-bending radiographs were analysed. Postoperatively, a minimum of 2 years clinical and imaging follow-up was performed of all patients. PSI was defined as a radiographic shoulder height difference of more than 20 mm.ResultsA total of 80 patients were included, and 14 patients (18%) were confirmed with PSI at final follow-up. The flexibility of MT curve was an independent risk factor for PSI (odds ratio (OR) = 3.3 per 10% decrease, 95% confidence interval (CI) 1.6-8.2). Twenty-seven patients had a preoperative MT flexibility of < 55% (OR = 11.5, 95% CI 2.8-46.2). Postoperative T1 tilt was significantly higher in the PSI group (p < 0.001), and a T1 tilt of more than 9° resulted in 7.2 times higher odds of developing PSI (95% CI 2.0-26.0). Fulcrum-bending correction index (FBCI) was significantly higher in the PSI group at final follow-up, and 25 patients had a final postoperative MT FBCI above 120% (OR = 8.5 (95% CI 2.3-31.0).ConclusionsA low preoperative curve flexibility is a significant predictor for PSI. The surgical strategy should consider proximal fusion in presence of low-flexibility MT curves and consider less aggressive MT curve correction. Achieving a level T1 should be a main priority during intraoperative correction and may require fusion of the PT curve.Level Of EvidenceIII. These slides can be retrieved under Electronic Supplementary Material.

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