Te Journal of Turkish Spinal Surgery 5 Volume: 29, Issue: 1, January 2018 pp: 5-11 ORIGINAL ARTICLE THE EFFECT OF PRE-AND POSTOP APICAL VERTEBRA ROTATION ON THE SHOULDER BALANCE AND SRS22-R SCORES IN ADOLESCENT IDIOPATHIC SCOLIOSIS Osman ÇİMEN 1 , Mehmet Bülent BALİOĞLU 2 , Mehmet Akif KAYGUSUZ 3 , M. Temel TACAL 4 1 Elazığ Hayat Hospital, Department of Orthopaedics and Traumatology, Elazığ, Turkey. 2 İstinye University LIV Hospital, Department of Orthopaedics and Traumatology, İstanbul, Turkey. 3 SBÜ Metin Sabancı Baltalimanı Bone and Joint Hospital, Department of Orthopaedics and Traumatology, Baltalimanı, İstanbul, Turkey 4 İstinye State Hospital, Department of Orthopaedics and Traumatology, İstinye, İstanbul, Turkey. Address: İstinye University LIV Hospital, Department of Orthopaedics and Traumatology, İstanbul, Turkey. Phone: +90532 2525 14 83 E-mail: mbbalibey@gmail.com Received: 3th September, 2017. Accepted: 29 th October, 2017 ABSTRACT Objective: To investigate the association between shoulder imbalance and AVR (apical vertebrae rotation) with AVR related ratios and how these radiological parameters effects patients postoperative functional and cosmetic outcomes by using SRS-22r scoring system. Methods: Adolescent Idiopathic scoliosis patients (n: 48) treated with posterior spinal surgery and followed up for more than 1 years were evaluated retrospectively. The rotation angle of the apical vertebra was measured using Drerup’s AVR measuring method in coronal plane radiograph. AVR improvement rate were calculated. Preoperative and postoperative follow-up shoulder balances were assessed by measuring CTAD (clavicular tilt angle difference) in the standing graphs. Results: According to the Pearson Correlation test there was a statistically mild negative correlation between postoperative shoulder balance and age of operation. There was an inverse moderate correlation between early postoperative apical vertebral rotation and postoperative shoulder balance. According to other tests (Benferroni ve Pillai’s Trace), AVR of patients with shoulder imbalance seems to have not improved in the postoperative period. Shoulder imbalance was found to be statistically significant in patients with poorly corrected postoperative AVR. Patients with good shoulder balance appeared to be composed of patients who showed better AVR recovery significantly in the early postoperative period. Conclusion: Using early postoperative AVR recovery in evaluating the surgical outcomes of patients with adolescent idiopathic scoliosis and the evaluation of follow-up progression may provide important contributions to orthopedic surgery. Nevertheless, there is a need for large populations and long follow-up studies to support this thinking. Key words: SRS-22r, Adolescent Idiopathic Scoliosis, shoulder balance, pain score, Lenke, Apical Vertebrae Rotation Level of Evidence: Retrospective clinic study, Level III INTRODUCTION The main purpose of surgical treatment for idiopathic scoliosis patients is to establish natural cosmesis and improve self-image. The success of surgical treatment is assessed with radiographic parameters and functional outcomes. Generally, patients are satisfied with a balanced spine, well-corrected rib hump, and balanced shoulders after the surgery. Although it is very important to provide subjective shoulder balance, it is difficult to evaluate and perform it by using conventional surgical methods. For this reason, radiographic shoulder balance is often used instead of subjective shoulder balance and is also considered as a critical parameter when judging the success of corrective surgery. Although there are many studies investigated several factors related to postoperative shoulder imbalance, no definite conclusions have been made. Also a few studies have investigated relationship between AVR and AVR related ratios with shoulder imbalance in the literature. In these studies no definite conclusions have been made too (1,6) . Therefore, we aimed to investigate the association between shoulder imbalance and AVR with AVR related ratios. During this investigation we used SRS- 22r scoring system as a patient related