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

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 standar...

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Bibliographic Details
Published in:	Journal of clinical medicine Vol. 11; no. 6; p. 1545
Main Authors:	Landrum, Matthew R, Milby, Andrew H, Yaszay, Burt, Parent, Stefan, Nelson, Susan E, Pahys, Joshua M, Samdani, Amer F, Capraro, Anthony C, Flynn, John M, Cahill, Patrick J, On Behalf Of The Harms Study Group And Harms Non-Fusion Study Group
Format:	Journal Article
Language:	English
Published:	Switzerland MDPI AG 11-03-2022 MDPI
Subjects:	Clinical medicine Patient satisfaction Quantitative analysis Self image Surgeons idiopathic scoliosis T1 tilt Lenke 2 curve correction posterior spinal fusion (PSF) thoracic curve correction ratio (TCCR)
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Summary:	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 left-proximal 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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Membership of the Group Name is provided in the Supplemental Materials.
ISSN:	2077-0383 2077-0383
DOI:	10.3390/jcm11061545