Evaluation of cosmetic shoulder balance in Lenke type 1 and 2 adolescent idiopathic scoliosis across different observational perspectives

Abstract Background: Shoulder imbalance in patients with adolescent idiopathic scoliosis (AIS) contributes to a negative self-image and psychological distress, particularly in those with Lenke type 1 or 2 curves. Although previous studies have emphasized the significance of cosmetic shoulder balance (Sh.B) in informing clinical decisions and evaluating postoperative patient-reported outcomes (PROs), the observational perspective—a crucial factor—has often been overlooked in cosmetic assessment, potentially leading to inaccuracies and inconsistencies in measurements. Therefore, this study aimed to identify potential disparities in cosmetic