Evidence map›Paper›PMID 39302587›Full record

ArticleSpine deformity2025

Rule breakers achieve successful shoulder balance: unraveling the myth of upper instrumented vertebrae selection criteria.

Luke C Drake, Peter W D'Amore, Bailli Fontenot, Tyler A Tetreault, Manaf Younis, Claudia Leonardi, Jaquelyn Valenzuela-Moss, Lindsay M Andras, Michael J Heffernan

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Article in Spine deformity, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Luke C DrakeUniversity of Mississippi Medical Center, Jackson, MS, USA.
Peter W D'AmoreChildren's Hospital New Orleans, LSU Health Science Center, New Orleans, LA, USA.
Bailli FontenotChildren's Hospital New Orleans, LSU Health Science Center, New Orleans, LA, USA.
Tyler A TetreaultJackie and Gene Autry Orthopaedic Center, Children's Hospital Los Angeles, Keck School of Medicine of USC, 4650 Sunset Blvd, Mailstop #69, Los Angeles, CA, 90027, USA.
Manaf YounisChildren's Hospital New Orleans, LSU Health Science Center, New Orleans, LA, USA.
Claudia LeonardiSchool of Public Health, LSU Health Science Center, New Orleans, LA, USA.
Jaquelyn Valenzuela-MossJackie and Gene Autry Orthopaedic Center, Children's Hospital Los Angeles, Keck School of Medicine of USC, 4650 Sunset Blvd, Mailstop #69, Los Angeles, CA, 90027, USA.
Lindsay M AndrasJackie and Gene Autry Orthopaedic Center, Children's Hospital Los Angeles, Keck School of Medicine of USC, 4650 Sunset Blvd, Mailstop #69, Los Angeles, CA, 90027, USA.
Michael J HeffernanJackie and Gene Autry Orthopaedic Center, Children's Hospital Los Angeles, Keck School of Medicine of USC, 4650 Sunset Blvd, Mailstop #69, Los Angeles, CA, 90027, USA. mheffernan@chla.usc.edu.ORCID 0000-0002-0632-3367

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeThis study compared shoulder balance outcomes in "rule breakers" (RB) vs. "rule followers" (RF) based on commonly utilized upper instrumented vertebrae (UIV) selection guidelines.

methodsAdolescent idiopathic scoliosis (AIS) patients (Lenke 1-4) who underwent posterior spine fusion (PSF) with minimum 2-year follow-up had radiographic measurement of shoulder balance including first rib angle (FRA), T1 tilt, coracoid process height difference (CPHD), and clavicle angle (CA) at preop, postop, 6-month, 1-year, and 2-year timepoints. Postoperative outcomes were compared between RB and RF groups defined based on the UIV selection guidelines of Rose and Lenke.

resultsAmong 88 patients (43 RF, 45 RB), age, gender, preoperative T1 tilt, FRA, CA, and CPHD were not significantly different between groups (p > 0.05). Immediately post-surgery, the RF group had more balanced shoulders (CPHD: 11.6 mm vs. 15.7 mm, p = 0.033; CA: 2.8° vs. 3.6°, p = 0.045; FRA: 3.4° vs. 5.1°, p = 0.009; T1 tilt: 4.7° vs. 6.1°, p = 0.045). At 2 years, no difference was observed between RF vs. RB in CA (2.3 vs. 2.2°, p = 0.857) and CPHD (8.5 vs. 8.1 mm, p = 0.791). FRA and T1 tilt were higher in RB vs. RF (FRA: 4.6 vs. 2.9°, p = 0.002; T1 tilt: 5.6 vs. 3.9, p = 0.008). Shoulder balance (CPHD < 1 cm) was achieved in 73.1% of RB and 69.9% of RF at 2-year follow-up (p = 0.216).

conclusionAdherence to commonly accepted UIV selection guidelines did not predict better shoulder balance. The RB group had worse shoulder balance immediately post-surgery, but also improved more over time. These results suggest the need to refine current UIV selection and management. LEVEL OF EVIDENCE: III.

Indexed as

Postural BalanceScoliosisShoulderSpinal FusionAdolescentChildFemaleFollow-Up StudiesHumansMaleRadiographyRetrospective StudiesThoracic VertebraeTreatment OutcomeAdolescent idiopathic scoliosisPosterior spinal fusionShoulder balanceUpper instrumented vertebrae

Identifiers

PMID39302587
PMCPMC11729094

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.