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Incidence and risk factors for postoperative shoulder imbalance in scoliosis: a systematic review and meta-analysis

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Abstract

Purpose

This is the first systematic review and meta-analysis to detect the incidence and risk factors for postoperative shoulder imbalance (PSI) in scoliosis.

Methods

A systematic online search was conducted to identify eligible studies. ES, OR and WMD with 95% CI were used to assess the incidence and risk factors associated with PSI.

Results

Twenty-six studies were recruited. The pooled incidence of PSI was 25% (95% CI 20–31%). The incidence in Lenke 1 AIS, Lenke 2 AIS, Lenke 5 AIS and mixed AIS was 20% (9–31%), 26% (15–37%), 31% (17–45%) and 27% (19–35%), respectively. Using RSH ≥10 mm as the criterion of PSI, we found that preoperative LC, postoperative RSH, correction rate of MTC at follow-up were primary risk factors for PSI at follow-up. In the analysis of using RSH ≥20 mm as the criterion of PSI, our results showed that Risser sign, postoperative RSH, correction rate of PTC at follow-up, and LC at follow-up were contributing to PSI. Besides, scoliosis patients with PSI were more likely to suffer from adding-on.

Conclusions

The pooled incidence of PSI in scoliosis was 25%. Risser sign, preoperative LC, postoperative RSH, correction rate of PTC at follow-up, correction rate of MTC at follow-up, and LC at follow-up were risk factors for PSI in patients with scoliosis. Adding-on might be a compensatory mechanism for PSI. It is recommended that (1) sufficient correction of PTC and moderate correction of MTC and LC in the operation should be performed; (2) PSI should be prevented not only for the patients’ postoperative appearance, but also for preventing the adding-on phenomenon.

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Authors and Affiliations

  1. Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, 215006, People’s Republic of China

    ShengFei Zhang & HuiLin Yang

  2. Department of Orthopaedics, Northern Jiangsu People’s Hospital, Yangzhou, 225001, People’s Republic of China

    ShengFei Zhang, Liang Zhang & XinMin Feng

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Correspondence to HuiLin Yang.

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Zhang, S., Zhang, L., Feng, X. et al. Incidence and risk factors for postoperative shoulder imbalance in scoliosis: a systematic review and meta-analysis. Eur Spine J 27, 358–369 (2018). https://doi.org/10.1007/s00586-017-5289-y

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  • DOI: https://doi.org/10.1007/s00586-017-5289-y

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