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Distal Adding-On as a Natural Shoulder Rebalancing Mechanism in Lenke Type 2A AIS with Right Sacral Slanting
Jae-Hyuk Yang1, Jae Min Park2, Hyukjune Seong2
1Department of Orthopedic Surgery, Korea University Anam Hospital, Seoul 02841, Republic of Korea.
Journal of Clinical Medicine
|October 16, 2025
Summary
Distal adding-on (DA) in adolescent idiopathic scoliosis (AIS) with right sacral slanting (RSS) may compensate for postoperative shoulder imbalance (PSI). Changes in distal wedge angle (DWA) and radiologic shoulder height (RSH) indicate this dynamic alignment.
Area of Science:
- Spine surgery
- Orthopedics
- Pediatric orthopedics
Background:
- Distal adding-on (DA) is common after adolescent idiopathic scoliosis (AIS) surgery.
- Postoperative shoulder imbalance (PSI) significantly impacts patient quality of life.
- Investigating DA and PSI in Lenke type 2A AIS is crucial.
Purpose of the Study:
- To analyze radiographic changes in DA and shoulder balance.
- To focus on distal wedge angle (DWA) and radiologic shoulder height (RSH).
- To evaluate patients with right sacral slanting (RSS).
Main Methods:
- Retrospective analysis of 120 Lenke type 2A AIS patients.
- Grouping patients by sacral slanting (RSS, LSS, NS).
- Assessing radiographic parameters (DWA, RSH) and using regression analysis.
Main Results:
- RSS group showed highest DWA and DA incidence.
- RSH decreased over time in all groups.
- Inverse relationship between DWA and RSH was most pronounced in the RSS group.
Conclusions:
- DA may compensate for PSI in Lenke type 2A AIS with RSS.
- Increasing DWA and decreasing RSH suggest dynamic alignment changes.
- Sacral slanting and RSH may predict these alignment changes.
