A prospective analysis of motion and deformity at the shoulder level in surgically treated adolescent idiopathic scoliosis

Background: Although posterior spinal correction and fusion surgery (PSF) of adolescent idiopathic scoliosis (AIS) limits counter rotation between thorax and pelvis, the physical function, and more specifically gait of these patients is only slightly affected after PSF. Possibly, shoulders-thorax counter-rotation increases to compensate for the loss in thorax-pelvis motion. This would subsequently result in a higher phase-difference and range of motion (ROM) between the shoulders and thorax. Research questions: What is the effect of PSF on the phase difference and ROM between the shoulders and thorax? What is the effect of PSF on upper body deformity? Methods: 18 AIS patients underwent gait analysis at increasing walking speeds (0.45 to 2.22 m/s) before, and 3 and 12 months after PSF. The phase difference, ROM, and deformity between the shoulders, thorax, and pelvis were calculated. Results: The shoulders- thorax phase difference was unaffected by surgery. At 3 months postoperatively the shoulders-thorax ROM was decreased (3.5° ± 0.2° versus 2.7° ± 0.2° p=0.001). This recovered to preoperative values 12 months postoperatively (3.2° ± 0.2° p=0.213). The shoulder-pelvis phase difference was decreased 3 months postoperatively (−98.9° ± 6.8° vs. −77.2° ± 7.2° p=0.010), and recovered to pre-op values at the 12 months postoperative measurement (−89.6° ± 6.9° p=0.290). Walking speed did not influence the effect of surgery on phase difference or ROM. The pre-operative shoulders-thorax asymmetry decreased from 3.4° ± 2.4° to 0.6° ± 3.1° (p<0.001). Shoulders-pelvis and thorax-pelvis asymmetry decreased from 10.0° ± 3.7° to 2.8° ± 4.3° (p<0.001) and from 6.5° ± 3.4° to 1.8° ± 3.2° (p=0.006) respectively. Significance: No compensatory mechanisms could be identified in the relative motion between the shoulders and the thorax. Possibly, compensatory mechanisms are not required for normal gait after surgery. The asymmetry of the shoulders in the transversal plane improved without specific surgical strategies.