For a study, researchers sought to determine if shoulder balance changes in patients who have had selective lumbar fusion for the adult spinal deformity (ASD) and, secondarily, if shoulder balance correlated with health-related quality of life (HRQOL) outcomes. Adult patients with thoracolumbar or lumbar scoliosis (Cobb angle > 30°) or sagittal plane deformity with thoracic compensatory curves (cobb angle > 10°) who had selective lumbar fusion (upper instrumented vertebra: T9–12, bottom instrumented vertebra: L4-Pelvis) were identified. Shoulder balance was measured using the clavicular angle (CA). Postoperatively, shoulder balance was categorized into 3 groups (balanced: CA<2°, mild imbalance: CA 2°–4°, severe imbalance: CA>4°). The average CA and proportion of patients in each shoulder balance group were compared at each postoperative time. Patients with HRQOL scores of 1 year after surgery were selected. There were 86 patients in total. CA was somewhere between 2.7 and 2.3° preoperatively and did not alter appreciably at discharge (2.9±2.4°), 6 weeks (2.5±2.1°), 6 months (2.4±2.2°), 1-year (2.4±2.5°), or 2-years (2.3±1.5°). From discharge to 6 weeks, 6 months, 1 year, and 2 years postoperatively, the proportion of patients in each shoulder balance group did not vary significantly (P>0.1). The CA had no significant link with the Oswestry Disability Index, Scoliosis Research Society (SRS)-22 score, or SRS-22 subscores after a year of follow-up. The Oswestry Disability Index, SRS-22 score, or SRS-22 subscores had no significant relationship with the shoulder balance group. Shoulder balance did not change in patients with ASD who underwent elective lumbar fusion after surgery. Shoulder balance had no link with HRQOL scores from a functional aspect. Shoulder balance might not be spontaneously correct in patients receiving selective lumbar fusion for ASD during the postoperative period, but this was unlikely to be of functional relevance.