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Author Notes:

Patrick J. Cahill, Email: cahillp1@chop.edu

Conceptualization, M.R.L., A.H.M., B.Y., S.P., S.E.N., J.M.P., A.F.S., A.C.C., J.M.F., Harms Study Group, and P.J.C.; methodology, P.J.C.; formal analysis, M.R.L., A.H.M., and Harms Study Group; investigation, P.J.C.; data curation, M.R.L., A.H.M., A.C.C., and Harms Study Group; writing—original draft preparation, M.R.L. and A.H.M.; writing—review and editing, M.R.L., A.H.M., B.Y., S.P., S.E.N., J.M.P., A.F.S., A.C.C., J.M.F., Harms Study Group, and P.J.C.; supervision, P.J.C., M.R.L., A.H.M., B.Y., S.P., S.E.N., J.M.P., A.F.S., A.C.C., and J.M.F.; project administration, P.J.C. All authors have read and agreed to the published version of the manuscript.

The authors declare no conflict of interest or financial relationships to disclose relevant to this article.

Subjects:

Research Funding:

This study was supported in part by grants to the Setting Scoliosis Straight Foundation in support of Harms Study Group research from DePuy Synthes Spine, EOS imaging, Stryker Spine, Medtronic, NuVasive, Zimmer Biomet and the Food and Drug Administration.

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Medicine, General & Internal
  • General & Internal Medicine
  • thoracic curve correction ratio (TCCR)
  • T1 tilt
  • idiopathic scoliosis
  • posterior spinal fusion (PSF)
  • Lenke 2 curve correction
  • ADOLESCENT IDIOPATHIC SCOLIOSIS
  • SHOULDER BALANCE
  • RECOGNITION
  • PATTERN
  • FUSION

Thoracic Curve Correction Ratio: An Objective Measure to Guide against Overcorrection of a Main Thoracic Curve in the Setting of a Structural Proximal Thoracic Curve

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Journal Title:

JOURNAL OF CLINICAL MEDICINE

Volume:

Volume 11, Number 6

Publisher:

Type of Work:

Article | Final Publisher PDF

Abstract:

Purpose: The correction of double thoracic (Lenke 2) curves has been associated with higher rates of postoperative shoulder imbalance that may compromise long-term outcomes following spinal deformity correction. A number of methods have been proposed to mitigate this risk, though no accepted standard measurement exists. The purpose of this study is to validate a novel quantitative method of determining the relative curve correction magnitude in double thoracic curves. Methods: Retrospective data from a multi-center database of patients undergoing surgical correction of leftproximal thoracic, right-main thoracic Lenke 2 curves were analyzed. A novel measurement tool, the Thoracic Curve Correction Ratio (TCCR), was applied for the purposes of validation against historical data. Results: A total of 305 patients with complete two-year follow-up data were included. The TCCR, or the ratio of postoperative percent correction of the thoracic curves divided by the ratio of the preoperative curve magnitudes, displayed a significant negative correlation (Pearson R = −0.66; p < 0.001) with T1 tilt at two years postoperatively. Conclusions: The TCCR could be added as an important factor in the preoperative planning process and intraoperative assessment in order to reduce postoperative T1 tilt. While T1 tilt remains an imperfect surrogate measure for clinical shoulder balance, it serves as one of many potential measures that the surgeon may evaluate quantitatively and radiographically.

Copyright information:

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/rdf).
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