title: Modified T4 hemivertebrectomy for persistent high left shoulder after surgery for double thoracic scoliosis.
abstract: METHODS
  Case report.
  
  
  OBJECTIVE
  To surgically regain shoulder balance in patients with adolescent idiopathic scoliosis after loss of alignment after posterior fusion for Lenke II deformity correction.
  
  
  BACKGROUND
  Shoulder balance is known to have a large effect on patient satisfaction after deformity correction. Previous studies have outlined guidelines for determining levels of instrumentation to prevent postoperative high left shoulder. However, to our knowledge, no study has provided instructions on how to correct coronal imbalance in patients with previously fused scoliosis. We describe a case using a T4 unilateral pedicle subtraction osteotomy and contralateral Smith-Petersen osteotomy to treat high left shoulder in a patient who had previously undergone posterior instrumented fusion for adolescent idiopathic scoliosis.
  
  
  METHODS
  The radiographs and clinical charts were reviewed for a 17-year-old female patient treated with a revision fusion and modified T4 hemivertebrectomy for a persistently high left shoulder after previous correction of a Lenke II idiopathic scoliosis.
  
  
  RESULTS
  A reduction in the T1 tilt angle from 19.2° to 10.1° and an improvement in the coronal Cobb angle of the proximal thoracic curve from 37° to 17° were obtained. Shoulder balance was greatly improved.
  
  
  CONCLUSIONS
  A proximal thoracic partial vertebrectomy with unilateral pedicle subtraction osteotomy and contralateral Smith-Petersen osteotomy is a technique that can be used to successfully correct fixed shoulder imbalance after posterior instrumented fusion of a double thoracic adolescent idiopathic scoliosis.
  
  
  METHODS
  N/A.
authors.affiliation: From the Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Lewis
authors.forename: Taylor E
authors.initials: TE
authors.lastname: Dear
authors.forename: Sam G N
authors.initials: SG
authors.lastname: Keshen
authors.forename: Noah D H
authors.initials: ND
authors.lastname: Lewis
mesh_terms: D000293:Adolescent; D005260:Female; D006801:Humans; D010027:Osteotomy / Q000379:methods*; D017060:Patient Satisfaction; D012600:Scoliosis / Q000601:surgery*; D012782:Shoulder / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D013904:Thoracic Vertebrae / Q000601:surgery*; D016896:Treatment Outcome