• John Alex Sielatycki, Meghan Cerpa, Eduardo C Beauchamp, Takayoshi Shimizu, Chao Wei, Suthipas Pongmanee, Hui Wang, Rui Xue, Rongping Zhou, Xinchun Liu, Jun Yang, Yuan Suomao, Lawrence G Lenke, and Harms Study Group.
• The Daniel and Jane Och Spine Hospital, New York Presbyterian/Columbia University Medical Center, New York, NY.
• Spine. 2019 Sep 1; 44 (17): E1031-E1037.

Study DesignRetrospective review of a prospectively collected multicenter database.ObjectiveTo assess how "overcorrection" of the main thoracic curve without control of the proximal curve increases the risk for shoulder imbalance in Lenke type 1 Adolescent Idiopathic Scoliosis (AIS).Summary Of Background DataPostop shoulder imbalance is a common complication following AIS surgery. It is thought that a more cephalad upper-instrumented vertebra (UIV) decreases the risk of shoulder imbalance in Lenke type 1 and 2 curves; however, this has not been proven.MethodsThirteen surgeons reviewed preop and 5-year postop clinical photos and PA radiographs of patients from a large multicenter database with Lenke type 1 and 2 AIS curves who were corrected with pedicle screw/rod constructs. Predictors of postop shoulder imbalance were identified by univariate analysis; multivariate analysis was done using the classification and regression tree method to identify independent drivers of shoulder imbalance.ResultsOne hundred forty-five patients were reviewed. The UIV was T3-T5 in 87% of patients, with 8.9% instrumented up to T1 or T2. Fifty-two (36%) had shoulder imbalance at 5 years. On classification and regression tree analysis when the proximal thoracic (PT) Cobb angle was corrected more than 52%, 80% of the patients had balanced shoulders. Similarly, when the PT curve was corrected less than 52% and the main thoracic (MT) curve was corrected less than 54%, 87% were balanced. However, when the PT curve was corrected less than 52%, and the MT curve was corrected more than 54%, only 41% of patients had balanced shoulders (P = 0.05). This relationship was maintained regardless of the UIV level.ConclusionIn Lenke type 1 and 2 AIS curves, significant correction of the main thoracic curve (>54%) with simultaneous "under-correction" (<52%) of the upper thoracic curve resulted in shoulder height imbalance in 59% of patients, regardless of the UIV. This suggests the PT curve must be carefully scrutinized in order to optimize shoulder balance, especially when larger correction of the MT curve is performed.Level Of Evidence2.

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