{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T20:15:02Z","timestamp":1788380102267,"version":"build-2803163510"},"reference-count":34,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2021,3,11]],"date-time":"2021-03-11T00:00:00Z","timestamp":1615420800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Global Spine Journal"],"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Retrospective.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>To evaluate the relationship between shoulder\/ neck imbalance with distal adding-on phenomenon and to identify other risk factors in Lenke 1 and 2 (non-AR curves) adolescent idiopathic scoliosis (AIS) patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      100 Lenke 1 and 2 AIS patients with lowest instrumented vertebra (LIV) cephalad to or at L1 were recruited. Medial shoulder\/ neck balance was represented by T1-tilt and cervical axis (CA). Lateral shoulder balance was represented by clavicle angle (Cla-A) and radiographic shoulder height (RSH). Distal adding-on phenomenon was diagnosed when there was disc wedging below LIV of &gt;5\n                      <jats:sup>o<\/jats:sup>\n                      at final follow-up. Predictive factors and odds ratio were derived using univariate and multivariate logistic regression analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Mean age of this cohort was 15.9 \u00b1 4.4 years. Mean follow-up duration was 30.9 \u00b1 9.6 months. Distal adding-on phenomenon occurred in 19 patients (19.0%). Only Risser grade, preoperative CA and final follow-up lumbar Cobb angle were the independent factors. A positive preoperative CA deviation increased the odds of distal adding-on by 5.4 times (95% CI 1.34-21.51, P = 0.018). The mean immediate postoperative T1-tilt, CA, RSH and Cla-A were comparable between the group with distal adding-on and the group without.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Distal adding-on phenomenon occurred in 19.0% of patients. Preoperative \u201cCervical Axis\u201d was an important factor and it increased the risk of distal adding-on by 5.4 times. Other significant predictive factors were Risser grade and lumbar Cobb angle at final follow-up. Immediate postoperative shoulder or neck imbalance was not a significant factor for postoperative distal adding-on phenomenon.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/2192568221998642","type":"journal-article","created":{"date-parts":[[2021,3,11]],"date-time":"2021-03-11T04:29:01Z","timestamp":1615436941000},"page":"443-450","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Preoperative \u201cCervical Axis\u201d Deviation Increases the Risk of Distal Adding-On Following Surgery in Lenke 1 and 2 Adolescent Idiopathic Scoliosis Patients"],"prefix":"10.1177","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7245-0295","authenticated-orcid":false,"given":"Chris Yin Wei","family":"Chan","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pei Ying","family":"Ch\u2019ng","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sin Ying","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weng Hong","family":"Chung","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4198-1541","authenticated-orcid":false,"given":"Chee Kidd","family":"Chiu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9512-3155","authenticated-orcid":false,"given":"Mun Keong","family":"Kwan","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2021,3,11]]},"reference":[{"key":"bibr1-2192568221998642","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000002423"},{"key":"bibr2-2192568221998642","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000002375"},{"key":"bibr3-2192568221998642","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000001761"},{"key":"bibr4-2192568221998642","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000001374"},{"key":"bibr5-2192568221998642","doi-asserted-by":"publisher","DOI":"10.1016\/j.jspd.2017.10.002"},{"key":"bibr6-2192568221998642","doi-asserted-by":"publisher","DOI":"10.1016\/j.jspd.2014.04.003"},{"key":"bibr7-2192568221998642","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e31824bac7a"},{"key":"bibr8-2192568221998642","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2008.06.772"},{"key":"bibr9-2192568221998642","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e3181f51e95"},{"key":"bibr10-2192568221998642","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2012.08.293"},{"key":"bibr11-2192568221998642","unstructured":"Kim YJ, Fischer CR, Lenke LG, et al. 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