Keck School of Medicine of USC, USC Spine Center, Los Angeles, CA.
Spine Service, Hospital for Special Surgery, New York, NY.
Spine (Phila Pa 1976). 2022 May 1;47(9):E385-E389. doi: 10.1097/BRS.0000000000004255. Epub 2021 Sep 21.
Retrospective review.
To analyze if shoulder balance continues to change in the postoperative period in patients undergoing selective lumbar fusion for adult spinal deformity (ASD), and secondarily, analyze if shoulder balance correlates with health-related quality of life (HRQOL) outcomes.
Shoulder balance in patients with ASD is poorly understood and has largely been extrapolated from adolescent scoliosis literature.
Adult patients who underwent selective lumbar fusion (upper instrumented vertebra: Τ9-Τ12, lower instrumented vertebra: L4-Pelvis) for thoracolumbar or lumbar scoliosis (cobb angle > 30°) or sagittal plane deformity with thoracic compensatory curves (cobb angle > 10°) were identified. The clavicular angle (CA) was used to quantify shoulder balance. Shoulder balance was categorized into three groups postoperatively (balanced: CA <2°, mild imbalance: CA 2°-4°, severe imbalance: CA >4°). The average CA and proportion of patients in each shoulder balance group were compared at each postoperative period. Patients with 1-year postoperative HRQOL scores were identified.
Eighty-six patients were included. The preoperative CA was 2.7 ± 2.3° and did not significantly change at discharge (2.9 ± 2.4°), 6-weeks (2.5 ± 2.1°), 6-months (2.4 ± 2.2°), 1-year (2.4 ± 2.5°), or 2-years (2.3 ± 1.5°) postoperatively. The proportion of patients in each shoulder balance group did not significantly change from discharge to 6-weeks, 6-months, 1-year or 2-years postoperatively (P > 0.1). At 1-year follow-up, the CA demonstrated no significant correlation with Oswestry Disability Index, Scoliosis Research Society (SRS)-22 score, or SRS-22 subscores. There was no significant association between shoulder balance group and Oswestry Disability Index, SRS-22 score, or SRS-22 subscores.
In patients with ASD undergoing selective lumbar fusion, shoulder balance did not change over the postoperative period. From a functional standpoint, shoulder balance demonstrated no correlation with HRQOL scores. In patients undergoing selective lumbar fusion for ASD, shoulder balance may not spontaneously correct over the postoperative period, but this may not be of functional consequence.Level of Evidence: 4.
回顾性研究。
分析成人脊柱畸形（ASD）患者接受选择性腰椎融合术后肩部平衡是否持续改变，并进一步分析肩部平衡是否与健康相关生活质量（HRQOL）结果相关。
ASD 患者的肩部平衡情况尚不清楚，很大程度上是从青少年脊柱侧凸文献中推断出来的。
确定了接受选择性腰椎融合术（上固定椎：T9-T12，下固定椎：L4-骨盆）治疗胸腰椎或腰椎侧凸（cobb 角>30°）或矢状面畸形伴胸椎代偿性弯曲（cobb 角>10°）的成年患者。使用锁骨角（CA）来量化肩部平衡。术后将肩部平衡分为三组（平衡：CA<2°，轻度不平衡：CA 2°-4°，严重不平衡：CA>4°）。比较每个术后时期的平均 CA 和每组患者的比例。确定了具有 1 年术后 HRQOL 评分的患者。
共纳入 86 例患者。术前 CA 为 2.7±2.3°，出院时（2.9±2.4°）、6 周时（2.5±2.1°）、6 个月时（2.4±2.2°）、1 年时（2.4±2.5°）和 2 年时（2.3±1.5°）均无明显变化。从出院到 6 周、6 个月、1 年和 2 年，每组患者的比例均无明显变化（P>0.1）。在 1 年随访时，CA 与 Oswestry 残疾指数、脊柱侧凸研究协会（SRS）-22 评分或 SRS-22 亚评分均无显著相关性。肩部平衡组与 Oswestry 残疾指数、SRS-22 评分或 SRS-22 亚评分之间也无显著相关性。
在接受选择性腰椎融合术治疗 ASD 的患者中，肩部平衡在术后期间没有改变。从功能角度来看，肩部平衡与 HRQOL 评分无相关性。在接受选择性腰椎融合术治疗 ASD 的患者中，肩部平衡可能不会在术后期间自发纠正，但这可能没有功能影响。
4 级。
