Adolescent idiopathic scoliosis: shoulder balance and SRS-22 patient-reported outcome

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Abstract
Background This is a retrospective database review with the objective to review adolescent idiopathic scoliosis (AIS) surgery in terms of radiographic and patient-reported surgical outcome, assessing the relationship with shoulder balance. Methods Database search identified 97 AIS patients who underwent single-stage corrective fusion between 2011 and 2017, and had one year follow-up. The average age at surgery was 15.0 (10.9-20.7 ± 2.1) years. Preoperative and one-year radiographic analysis included Cobb angles, flexibility and correction indices. The curves were classified according to Lenke as 43 type 1, 14 type 2, 11 type 3, 12 type 4, 12 type 5 and five type 6. Shoulder balance was assessed by T1 tilt angle, clavicle angle and shoulder height. Pre-and postoperative Scoliosis Research Society (SRS)-22 patient-reported outcome measures (PROMs) were assessed in relation to the radiographic results. Results In Lenke 1-4, the preoperative Cobb angle was 64.4° (26-99 ± 15.69), with a flexibility index of 28% corrected to 22.8° (6-62 ± 11.4). Lenke 5-6 thoracolumbar (TL) was corrected from 56.8° (30-88 ± 143), with a flexibility index of 46% to 12.7° (0-34 ± 7.9). Overall SRS-22 postoperative satisfaction was high at 9.6 (6-10 ± 0.9), with improvement in self-image and mental health domains. While preoperative T1 tilt angle was associated, clavicle angle and shoulder height showed no difference in SRS-22 score. Conclusion Surgery improved SRS-22 PROMs overall, as well as self-image and mental health domains. Radiographic shoulder imbalance did not negatively affect the PROM.

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