Improving shoulder balance in lenke type 2 and 4 adolescent idiopathic scoliosis: clinical advantages of a proximal thoracic concave rod technique.

Abstract

To evaluate a novel proximal thoracic concave rod (PTCR) technique for improving postoperative shoulder imbalance (SI) in adolescent idiopathic scoliosis (AIS) patients with Lenke types 2 and 4 curves, compared to conventional methods. A retrospective study of 30 AIS patients (10 with PTCR, 20 without) from a multicentric European database was conducted. Patients aged ≤ 18 years undergoing surgery for Lenke types 2 or 4 curves with ≥ 2 years of follow-up were included. Radiographic parameters, including Clavicle Angle (CA) and T1 Coronal Tilt (T1CT), were assessed preoperatively, immediately postoperatively, and at 2 years. Demographic, surgical, radiological parameters, and patient-reported outcomes measures (PROMs) were compared between groups. PTCR significantly improved SI, achieving optimal CA in 80% of cases versus 35% in the non-PTCR group (p = 0.02). CA correction was superior in the PTCR group (-1.66° ± 1.34° vs. 1.06 ± 2.59°, p < 0.001). While T1CT correction showed greater improvement in the PTCR group (-3.62° ± 5.56° vs. -0.31° ± 8.13°) it was not statistically significant (p = 0.258). PTCR did not increase surgical time, blood loss, or complications. PTCR is a promising approach for managing shoulder imbalance in AIS patients with Lenke types 2 or 4 curves. Larger prospective studies are necessary to validate these findings. Level of Evidence: III.