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.
Abudayeh et al. (Wed,) studied this question.