Modified T4 Hemivertebrectomy for Persistent High Left Shoulder After Surgery for Double Thoracic Scoliosis
Bibliographic record
Abstract
STUDY DESIGN: 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. SUMMARY OF BACKGROUND DATA: 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. CONCLUSION: 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. LEVEL OF EVIDENCE: N/A.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".