The prevalence of coronal imbalance at the last follow-up remained high in severe and rigid scoliosis. Postoperative shoulder imbalance and residual trunk shift could be used as predictors for ultimate coronal imbalance. The aggravation of coronal imbalance might represent a possible compensatory response to shoulder imbalance, as suggested by the observed adverse trends. However, this interpretation should be considered hypothetical, since a direct causal relationship could not be verified yet. Surgeons should pay attention to restore an appropriate relationship between curves in surgical planning for better results.
Yang et al. (2026) studied this question.