ArticleBMC surgery2026
Matters arising: statistical overfitting and outcome discordance undermine the claimed superiority of T2 fusion for shoulder balance in adolescent idiopathic scoliosis.
Article in BMC surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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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.
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Abstract
A recent study by Li et al. evaluated shoulder balance in Lenke type 2 adolescent idiopathic scoliosis and concluded that the ratio of proximal to main thoracic curve (PTC/MTC) correction independently predicts postoperative shoulder imbalance (PSI), further suggesting that fusion to T2 provides superior shoulder balance compared with fusion to T3/4. A re-examination of the study's methodology indicates that these conclusions are compromised by two principal limitations: (1) statistical overfitting and quasi-separation within the multivariable logistic regression model used to identify predictors of PSI, and (2) lack of alignment between radiographic findings and patient-reported outcomes. These methodological and interpretive issues are well recognized in the clinical and statistical literature, and addressing them is essential for ensuring valid inference and accurate clinical interpretation.
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