{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T20:46:56Z","timestamp":1785444416886,"version":"3.56.0"},"reference-count":20,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["PED"],"published-print":{"date-parts":[[2016,12]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Postoperative shoulder imbalance (PSI) is a critical consideration after corrective surgery for a double thoracic curve (Lenke Type 2); however, the radiographic factors related to PSI remain unclear. The purpose of this study was to identify the radiographic factors related to PSI after corrective surgery for adolescent idiopathic scoliosis (AIS) in patients with a double thoracic curve.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>This study included 80 patients with Lenke Type 2 AIS who underwent corrective surgery. Patients were grouped according to the presence [PSI(+)] or absence [PSI(\u2212)] of shoulder imbalance at the final follow-up examination (differences of 20, 15, and 10 mm were used). Various radiographic parameters, including the Cobb angle of the proximal and middle thoracic curves (PTC and MTC), radiographic shoulder height (RSH), clavicle angle, T-1 tilt, trunk shift, and proximal and distal wedge angles (PWA and DWA), were assessed before and after surgery and compared between groups.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Overall, postoperative RSH decreased with time in the PSI(\u2212) group but not in the PSI(+) group. Statistical analyses revealed that the preoperative Risser grade (p = 0.048), postoperative PWA (p = 0.028), and postoperative PTC\/MTC ratio (p = 0.011) correlated with PSI. Presence of the adding-on phenomenon was also correlated with PSI, although this result was not statistically significant (p = 0.089).<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>Postoperative shoulder imbalance is common after corrective surgery for Lenke Type 2 AIS and correlates with a higher Risser grade, a larger postoperative PWA, and a higher postoperative PTC\/MTC ratio. Presence of the distal adding-on phenomenon is associated with an increased PSI trend, although this result was not statistically significant. However, preoperative factors other than the Risser grade that affect the development of PSI were not identified by the study. Additional studies are required to reveal the risk factors for the development of PSI.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2016.6.peds16162","type":"journal-article","created":{"date-parts":[[2016,9,23]],"date-time":"2016-09-23T13:58:48Z","timestamp":1474639128000},"page":"744-752","source":"Crossref","is-referenced-by-count":40,"title":["A retrospective study to reveal factors associated with postoperative shoulder imbalance in patients with adolescent idiopathic scoliosis with double thoracic curve"],"prefix":"10.3171","volume":"18","author":[{"given":"Choon Sung","family":"Lee","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang Ju","family":"Hwang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eic Ju","family":"Lim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong-Ho","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jae Hwan","family":"Cho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-peds16162","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"E705","DOI":"10.1097\/BRS.0000000000000325","article-title":"Association of postoperative shoulder balance with adding-on in Lenke Type II adolescent idiopathic scoliosis","volume":"39","author":"Cao","year":"2014"},{"key":"b2-peds16162","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"E1359","DOI":"10.1097\/BRS.0000000000000578","article-title":"How to improve shoulder balance in the surgical correction of double thoracic adolescent idiopathic scoliosis","volume":"39","author":"Chang","year":"2014"},{"key":"b3-peds16162","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2550","DOI":"10.1097\/01.brs.0000186579.74398.15","article-title":"The validity of Lenke criteria for defining structural proximal thoracic curves in patients with adolescent idiopathic scoliosis","volume":"30","author":"Cil","year":"2005"},{"key":"b4-peds16162","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"E1684","DOI":"10.1097\/BRS.0b013e3182a18486","article-title":"Reliability analysis of shoulder balance measures: comparison of the 4 available methods","volume":"38","author":"Hong","year":"2013"},{"key":"b5-peds16162","series-title":"J Pediatr Orthop","doi-asserted-by":"publisher","first-page":"733","DOI":"10.1097\/BPO.0b013e318185a36b","article-title":"How to determine the upper level of instrumentation in Lenke types 1 and 2 adolescent idiopathic scoliosis: a prospective study of 132 patients","volume":"28","author":"Ilharreborde","year":"2008"},{"key":"b6-peds16162","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"1966","DOI":"10.1097\/00007632-200109150-00006","article-title":"Spontaneous proximal thoracic curve correction after isolated fusion of the main thoracic curve in adolescent idiopathic scoliosis","volume":"26","author":"Kuklo","year":"2001"},{"key":"b7-peds16162","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"1599","DOI":"10.1097\/00007632-199309000-00006","article-title":"Analysis of the upper thoracic curve in surgically treated idiopathic scoliosis. 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