1
|
Domenech P, Mariscal G, Marquina V, Bas P, Bas T. Efficacy and safety of halo-gravity traction in the treatment of spinal deformities: A systematic review of the literature. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:159-167. [PMID: 37230411 DOI: 10.1016/j.recot.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVE To determine, through a systematic review, the effects of halo gravity traction in spinal deformity. METHODS Prospective studies or case series of patients with scoliosis or kyphosis treated with cranial halo gravity traction (HGT) were included. Radiological outcomes were measured in the sagittal and/or coronal planes. Pulmonary function was also assessed. Perioperative complications were also collected. RESULTS Thirteen studies were included. Congenital etiology was the most frequent etiology observed. Most studies provided clinically relevant curve correction values in the sagittal and coronal planes. Pulmonary values improved significantly after the use of HGT. Finally, there were a pool of 83 complications in 356 patients (23.3%). The most frequent complications were screw infection (38 cases). CONCLUSIONS Preoperative HGT appears to be a safe and effective intervention for deformity that allows correction prior to surgery. However, there is a lack of homogeneity in the published studies.
Collapse
Affiliation(s)
- P Domenech
- Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - G Mariscal
- Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital, Valencia, Spain.
| | - V Marquina
- Department of Orthopedic Surgery and Traumatology, Valencia General University Hospital, Valencia, Spain
| | - P Bas
- Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - T Bas
- Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital, Valencia, Spain
| |
Collapse
|
2
|
Domenech P, Mariscal G, Marquina V, Bas P, Bas T. Efficacy and safety of halo-gravity traction in the treatment of spinal deformities: A systematic review of the literature. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:T159-T167. [PMID: 38000543 DOI: 10.1016/j.recot.2023.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/17/2023] [Indexed: 11/26/2023] Open
Abstract
OBJECTIVE To determine, through a systematic review, the effects of halo-gravity traction (HGT) in spinal deformity. METHODS Prospective studies or case series of patients with scoliosis or kyphosis treated with cranial HGT were included. Radiological outcomes were measured in the sagittal and/or coronal planes. Pulmonary function was also assessed. Perioperative complications were also collected. RESULTS Thirteen studies were included. Congenital etiology was the most frequent etiology observed. Most studies provided clinically relevant curve correction values in the sagittal and coronal planes. Pulmonary values improved significantly after the use of HGT. Finally, there were a pool of 83 complications in 356 patients (23.3%). The most frequent complications were screw infection (38 cases). CONCLUSIONS Preoperative HGT appears to be a safe and effective intervention for deformity that allows correction prior to surgery. However, there is a lack of homogeneity in the published studies.
Collapse
Affiliation(s)
- P Domenech
- Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital, Valencia, España
| | - G Mariscal
- Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital, Valencia, España.
| | - V Marquina
- Department of Orthopedic Surgery and Traumatology, Valencia General University Hospital, Valencia, España
| | - P Bas
- Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital, Valencia, España
| | - T Bas
- Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital, Valencia, España
| |
Collapse
|
3
|
Langlais T, Josse A, Violas P. Frontal correction assessment in severe adolescent idiopathic scoliosis surgery using halo gravity traction before to posterior vertebral arthrodesis: a multicenter retrospective observational study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:713-722. [PMID: 38135731 DOI: 10.1007/s00586-023-08062-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 10/01/2023] [Accepted: 11/21/2023] [Indexed: 12/24/2023]
Abstract
PURPOSE Preoperative preparation with halo gravity traction (HGT) has several advantages but is still controversial. A multicenter, observational, retrospective study was conducted to determine whether HGT provides better frontal correction in surgery for adolescent idiopathic scoliosis (AIS). METHODS Between 2010 and 2020, all patients who underwent posterior spinal fusion (PSF) AIS with a Cobb angle greater than 80° were included. The included patients who underwent HGT were compared (complications rate and radiographic parameters) to patients who did not undergo traction (noHGT). For patients who underwent HGT, a spinal front X-ray at the end of the traction procedure was performed. RESULTS Sixty-four in noHGT and forty-seven in HGT group were analyzed with a 31-month mean follow-up. The mean ratio of Cobb angle correction was 58.8% in noHGT and 63.6% in HGT group (p = 0.023). In HGT, this ratio reached 9% if the traction lasted longer than 30 days (p = 0.009). The complication rate was 11.7% with a rate of 6.2% in noHGT and 19.1% in HGT group (p = 0.07). In patient whose preoperative Cobb angle was greater than 90°, the mean ratio of Cobb angle correction increases to 6.7% (p = 0.035) and the complications rate increased to 14% in the no HGT group and decreased to 13% in the HGT group (p = 0.9). CONCLUSION HGT preparation in the management of correction of AIS with a Cobb angle greater than 90° is a technique providing a greater frontal correction gain with similar complication rate than PSF correction alone. We recommend a minimum halo duration of 4 weeks.
Collapse
Affiliation(s)
- Tristan Langlais
- Department of Pediatric Orthopedic Surgery, Purpan Children's Hospital, Toulouse University, 330 Avenue de la Grande Bretagne, 31000, Purpan, Toulouse, France.
- IMFT UMR CNRS 5502, Toulouse University, Purpan, Toulouse, France.
| | - Antoine Josse
- Department of Pediatric Orthopedic Surgery, Children's Hospital, Lyon, France
| | - Philippe Violas
- Department of Pediatric Surgery, Hôpital Sud, Rennes University, Rennes, France
| |
Collapse
|
4
|
Sarmiento JM, Fakhoury J, Singh A, Hawk C, Sethi K, Bains R. Three-stage correction of severe idiopathic scoliosis with limited skeletal traction during a humanitarian surgical mission: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2023; 6:CASE23311. [PMID: 37773766 PMCID: PMC10555575 DOI: 10.3171/case23311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 07/20/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND Underprivileged and underserved patients from developing countries often present late with advanced, untreated spinal deformities. We report a three-stage all-posterior approach using limited skeletal traction with Gardner-Wells tongs (GWTs) for the management of severe idiopathic scoliosis during a humanitarian surgical mission trip. OBSERVATIONS A 17-year-old high-school female was previously diagnosed with juvenile idiopathic scoliosis (diagnosed at age 8) and progressed to a severe 135° kyphoscoliosis. Procedural stage 1 involved spinal instrumentation and posterior releases via posterior column osteotomies from T3 to L4. She then underwent 7 days of skeletal traction with GWTs in the intensive care unit as stage 2. In stage 3, rod engagement, posterior spinal fusion, and partial T10 vertebral column resection were performed. There were no changes in intraoperative neuromonitoring during either surgery and she woke up neurologically intact after both stages of the surgical procedure. LESSONS Skeletal traction with GWTs is a viable alternative to traditional halo-gravity traction in settings with limited resources. Three-stage spinal deformity correction using limited skeletal traction is a feasible and effective approach for managing severe scoliosis during humanitarian surgical mission trips.
Collapse
Affiliation(s)
- J. Manuel Sarmiento
- Standing Straight, Inc., Orinda, California
- Department of Pediatric Orthopedic Surgery, Morgan Stanley Children’s Hospital of New York-Presbyterian/Columbia University Irving Medical Center, New York, New York
| | - Jordan Fakhoury
- Standing Straight, Inc., Orinda, California
- Northern California Regional Spine Center, Kaiser Permanente Oakland Medical Center, Oakland, California; and
| | | | | | | | - Ravi Bains
- Standing Straight, Inc., Orinda, California
- Northern California Regional Spine Center, Kaiser Permanente Oakland Medical Center, Oakland, California; and
| |
Collapse
|
5
|
Faldini C, Viroli G, Barile F, Manzetti M, Ialuna M, Traversari M, Vita F, Ruffilli A. One stage correction via the Hi-PoAD technique for the management of severe, stiff, adolescent idiopathic scoliosis curves > 90°. Spine Deform 2023; 11:957-967. [PMID: 36811705 PMCID: PMC10260697 DOI: 10.1007/s43390-023-00663-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 02/04/2023] [Indexed: 02/24/2023]
Abstract
STUDY DESIGN Retrospective cohort study. PURPOSE to assess the efficacy and safety of Hi-PoAD technique in patients with a major thoracic curve > 90°, < 25% of flexibility and deformity spread over more than five vertebral levels. METHODS retrospective review of AIS patients with a major thoracic curve (Lenke 1-2-3) > 90°, with < 25% of flexibility and deformity spread over more than five vertebral levels. All were treated via the Hi-PoAD technique. Radiographic and clinical score data were collected pre-operatively, operatively, at 1 year, 2 years and at last follow-up (2 years minimum). RESULTS 19 patients were enrolled. A 65.0% correction rate of the main curve was achieved, from 101.9° to 35.7° (p < 0.001). The AVR reduced from 3.3 to 1.3. The C7PL/CSVL reduced from 1.5 to 0.9 cm (p = 0.013). Trunk Height increased from 31.1 to 37.0 cm (p < 0.001). At the final follow-up no significant changes, except from an improvement in C7PL/CSVL (from 0.9 cm to 0.6 cm; p = 0.017). SRS-22 increased in all patients, from 2.1 to 3.9 at 1 year of follow-up (p < 0.001). 3 patients had a transient drop of MEP and SEP during maneuver and were managed with temporary rods and a second surgery after 5 days. 2 of these 3 cases (66.7%) had a Total-Deformity Angular Ratio (T-DAR) > 25; conversely, among patients who had a one-stage procedure, only 1 (6.2%) had a T-DAR > 25 (p = 0.008). CONCLUSIONS The Hi-PoAD technique proved to be a valid alternative for the treatment of severe, rigid AIS involving more than 5 vertebral bodies. STUDY DESIGN Retrospective comparative cohort study. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Cesare Faldini
- Department of Biomedical and Neuromotor Science-DIBINEM, 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Giovanni Viroli
- Department of Biomedical and Neuromotor Science-DIBINEM, 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy.
| | - Francesca Barile
- Department of Biomedical and Neuromotor Science-DIBINEM, 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Marco Manzetti
- Department of Biomedical and Neuromotor Science-DIBINEM, 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Marco Ialuna
- Department of Biomedical and Neuromotor Science-DIBINEM, 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Matteo Traversari
- Department of Biomedical and Neuromotor Science-DIBINEM, 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Fabio Vita
- Department of Biomedical and Neuromotor Science-DIBINEM, 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Alberto Ruffilli
- Department of Biomedical and Neuromotor Science-DIBINEM, 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| |
Collapse
|
6
|
Liu D, Yang J, Sui W, Deng Y, Li F, Yang J, Huang Z. Efficacy of Halo-Gravity Traction in the Perioperative Treatment of Severe Scoliosis and Kyphosis: A Comparison of Adolescent and Adult Patients. World Neurosurg 2022; 166:e70-e76. [PMID: 35809839 DOI: 10.1016/j.wneu.2022.06.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The objective of the study was to compare the efficacy of halo-gravity traction (HGT) with subsequent surgical treatment in adolescent and adult patients with severe scoliosis by evaluating the radiographic outcomes and clinical complications. METHODS We performed a retrospective analysis of 51 patients with severe scoliosis who underwent a posterior spinal instrumented fusion with HGT during the perioperative period between March 2010 and June 2017. The patients were divided into 2 groups: adults (age >18 years) and adolescents (age 10-18 years). All patients were followed with full posteroanterior and lateral spine radiographs, bending films, neurological complications, and lung function tests for a minimum of 2 years. Deformity correction, pulmonary function testing, and clinical complications were compared between the 2 groups. RESULTS We identified 29 adults (8 males and 21 females, mean age = 23.7 ± 8.7 years) and 22 adolescents (10 males and 12 females, mean age = 13.0 ± 4.5 years). In the adult group, the mean Cobb angle of the main curve before HGT was 141.7 ± 18.2°, which improved to 126.4 ± 8.6° and 67.5 ± 10.2° after traction and operation, respectively. The kyphotic angle was corrected from 137.1 ± 15.6° before traction to 122.5 ± 11.3° after traction to 67.6 ± 13.8° after operation. The mean functional vital capacity% and forced expiratory volume in one second% were 43.1% and 37.5%, which improved to 46.7% and 41.7% after traction, respectively. In the adolescent group, the mean correction of the main curve improved from 139.3 ± 12.6° before traction to 112.1 ± 8.3° after traction to 59 ± 13.1° after surgical intervention. The kyphotic angle was corrected from 130.7 ± 9.4° before traction to 101.5 ± 12.2° after traction and then to 48.2 ± 10.1° after surgical intervention. Overall, patients in both groups showed significant improvement in their main scoliosis and kyphosis (P < 0.05), while the correction rate of the main curve and kyphosis was significantly higher in the adolescent group than that in the adult group (P < 0.05). The functional vital capacity% increased from 44.8% to 55.0% and the forced expiratory volume in one second% increased from 44.0% to 51.0% after using HGT. In terms of surgical outcomes, the incidence of postoperative neurological complications was 27.6% and 18.2% in the 2 groups, respectively. CONCLUSIONS HGT is an effective and safe method to correct spinal deformities and improve lung function, especially in adolescent patients with severe scoliosis. In addition, it can potentially reduce the risk of neurological complications and the level of osteotomy in posterior spinal instrumented fusion surgery.
Collapse
Affiliation(s)
- Delong Liu
- Department of orthopedic, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Jingfan Yang
- Spine Center, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wenyuan Sui
- Spine Center, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yaolong Deng
- Spine Center, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Fenghua Li
- Zhongshan Primary and Secondary School Student Health Care Center, Zhongshan, Guangdong, China
| | - Junlin Yang
- Spine Center, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zifang Huang
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.
| |
Collapse
|
7
|
Reed LA, Mihas A, Butler R, Pratheep G, Manoharan SR, Theiss S, Viswanathan VK. Halo Gravity Traction for the Correction of Spinal Deformities in the Pediatric Population: A Systematic Review and Meta-Analysis. World Neurosurg 2022; 164:e636-e648. [PMID: 35577210 DOI: 10.1016/j.wneu.2022.05.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 05/06/2022] [Accepted: 05/07/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Halo gravity traction (HGT) is an effective way of managing pediatric spinal deformities in the preoperative period. This study comprehensively reviews the existing literature and evaluates the effect of HGT on various radiographic parameters regarding spinal correction and, secondarily, evaluates the improvement in pulmonary function as well as nutritional status. METHODS In accordance with PRISMA guidelines, a comprehensive search was conducted for articles on HGT in the treatment of spinal deformity. Spinal deformity after traction and surgery, change of pulmonary function, nutritional status, and prevalence of complications were the main outcome measurements. All meta-analyses were conducted using random models according to the between-study heterogeneity, estimated with I2. RESULTS A total of 694 patients from 24 studies were included in this review. Compared with pretraction values, the average coronal Cobb angle reduction after traction was 27.66° (95% confidence interval [CI], 23.41-31.90; P < 0.001) and 47.43° (95% CI, 39.32-55.54; P < 0.001) after surgery. The sagittal Cobb angle reduction after HGT and surgery was 27.23° (95% CI, 22.83-31.62; P <0.001) and 36.77° (95% CI, 16.90-56.65; P < 0.001), respectively. There was a statistically significant improvement in the overall pulmonary function, as evident by an increase in a forced vital capacity of 8.44% (95% CI, -5.68 to -11.20; P < 0.001), and an increase in nutritional status, with a percentage correction of body mass index by 1.58 kg/m2 (95% CI, -2.14 to -1.02; P < 0.001) after HGT application. CONCLUSIONS HGT has been shown to significantly improve coronal deformities, sagittal deformities, nutritional status, and pulmonary function in the preoperative period.
Collapse
Affiliation(s)
- Logan A Reed
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
| | - Alexander Mihas
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Reed Butler
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Guna Pratheep
- Department of Spine Surgery, Ganga Medical Center and Hospitals, Coimbatore, India
| | | | - Steven Theiss
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | |
Collapse
|
8
|
Abstract
PURPOSE The correction of severe, stiff scoliosis in children is challenging. One method used to reduce the risk is preoperative halo gravity traction (HGT). In this study, the authors sought to define the efficiency and safety of HGT and characterize the chronology of the correction seen. METHOD A consecutive group of pediatric patients with severe spinal deformities was treated with HGT before definitive correction. A standard protocol with the daily addition of weight to 50% of body weight at 3 weeks was used. Traction remained in place until signs of impending neurological complication or 6 weeks, whichever was sooner. RESULTS Twenty-four patients were included with a mean age of 11.8 years. The mean coronal deformity was 123 degrees, with a T1-L5 height of 234 mm. The mean duration of traction was 42 days with a mean improvement in height of 72 mm with 82% occurring over the first 3 weeks. Hundred percent of the angular and 98% of T1-L5 height correction was reached by 6 weeks.One patient showed early signs of a cranial nerve palsy prompting early surgery and 8 patients showed pin loosening, 1 of which required revision of their halo. One patient underwent a slower progression of traction because of transitory urinary disturbance. Following fusion, angular correction of the major curve was 49%. CONCLUSION HGT is a safe treatment for severe, stiff scoliosis because it can respond to early signs of impending neurological impairment. The first 3 weeks of treatment, reaching 50% of body weight as a traction force accounts for 80% of correction, with the remaining 20% in the following 2 weeks. At least 4 weeks of traction is recommended when following this protocol.
Collapse
Affiliation(s)
- Brett Rocos
- Department of Orthopaedic Surgery, Hospital for Sick Children, Toronto, ON, Canada
| | - Luke Reda
- Department of Orthopaedic Surgery, Hospital for Sick Children, Toronto, ON, Canada
| | - David E Lebel
- Department of Orthopaedic Surgery, Hospital for Sick Children, Toronto, ON, Canada
| | - Michael K Dodds
- Department of Trauma and Orthopaedic Surgery, Mater Misericordiae University Hospital and Children's University Hospital, Rotunda, Dublin, Ireland
| | - Reinhard Zeller
- Department of Orthopaedic Surgery, Hospital for Sick Children, Toronto, ON, Canada
| |
Collapse
|
9
|
How helpful is the halo-gravity traction in severe spinal deformity patients?: A systematic review and meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:3162-3171. [PMID: 34185131 DOI: 10.1007/s00586-021-06902-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/14/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE This study sought to evaluate the complications and clinic outcome in radiographic parameters, pulmonary function, and nutritional status of halo-gravity traction (HGT) in treating severe spinal deformity. METHODS Embase, PubMed, Cochrane, Web of Science databases were searched comprehensively for relevant studies from inception to February 2021, by using combined text and MeSH terms and English language restriction was used. The data, including radiographic parameters, pulmonary function (FVC %), and nutritional status (BMI) was extracted from included studies. All meta-analyses were conducted using random or fixed-effects models according the between-study heterogeneity, estimated with I2. RESULTS Four hundred and forty-six studies were identified and twelve studies with a total of 372 patients were included in this review. Compared with pre-traction values, there were reduction in cobb angle of 28.12° [95% CI (22.18, 34.18)], decrease in thoracic kyphosis of 26.76°[95% CI (20.73, 32.78)], improvements in spine height[SMD = -0.89, 95% CI (- 1.56, - 0.21)] and in coronal balance[WMD = - 0.03, 95% CI (- 1.56, - 0.21), P = 0.84] with preoperative halo-gravity traction for severe spinal deformity patients. Besides, our pooled analysis showed the improvement in pulmonary function (FVC %) [WMD = - 9.56, 95% CI (- 1.56, - 0.21)] and increase in nutritional status (BMI) [WMD = - 0.50, 95% CI (- 1.56, - 0.21)]. CONCLUSION Partial correction can be achieved by preoperative HGT, thereby reducing the difficulty of the operation and the risk of neurologic injury caused by excessive correction. Moreover, preoperative HGT can improve pulmonary function and nutritional status and, thus, increase patients' tolerance to surgery.
Collapse
|
10
|
Wright DN, Kieser DC, Cunningham G, Liantis P, Hunt R, Ember TM, Kumar MM, Pereira EAC, Lucas JD. Halo Femoral Traction for 1 Week Between Staged Anterior and Posterior Fusion Surgeries for Severe Adolescent Scoliosis Is Effective and Safe. World Neurosurg 2020; 141:e998-e1004. [PMID: 32585379 DOI: 10.1016/j.wneu.2020.06.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/12/2020] [Accepted: 06/14/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To report the outcomes of halo femoral traction (HFT) used for 1 week between anterior release and definitive posterior fusion in adolescents with severe rigid scoliosis. METHODS A retrospective single-center review of 22 consecutive patients (mean age at surgery, 14.1 years; range, 10.5-18.2 years; 17 girls) with severe, rigid scoliosis treated with anterior release, followed by HFT for 7 days prior to posterior instrumented fusion. Cobb angles were measured preoperatively, 1 week after anterior release and traction, after posterior fusion, and at a minimum 2-year follow-up. Complications were recorded. RESULTS Mean preoperative Cobb angle was 97° (range, 80°-118°), correcting to 52° with anterior release and HFT and 31° after posterior fusion. This equated to a 68% deformity correction and was maintained at final follow-up. Three traction-related complications were experienced, including 1 case of neck pain and 2 cases of brachial plexopathy that resolved with traction weight reduction. CONCLUSIONS Three-staged deformity correction using HFT for 1 week only offers gradual correction of the spine over sufficient time to optimize deformity correction yet minimizes neurologic dysfunction.
Collapse
Affiliation(s)
- Daniel N Wright
- Spinal Unit, Department of Orthopaedic Surgery, Guy's and St Thomas' NHS Foundation Trust and Evelina London Children's Hospital, London, England
| | - David C Kieser
- Department of Orthopaedics and Musculoskeletal Medicine, University of Otago, Christchurch School of Medicine, Christchurch, New Zealand.
| | - Gregory Cunningham
- Spinal Unit, Department of Orthopaedic Surgery, Guy's and St Thomas' NHS Foundation Trust and Evelina London Children's Hospital, London, England
| | - Panagiotis Liantis
- Spinal Unit, Department of Orthopaedic Surgery, Guy's and St Thomas' NHS Foundation Trust and Evelina London Children's Hospital, London, England
| | - Rachel Hunt
- Spinal Unit, Department of Orthopaedic Surgery, Guy's and St Thomas' NHS Foundation Trust and Evelina London Children's Hospital, London, England
| | - Thomas M Ember
- Spinal Unit, Department of Orthopaedic Surgery, Guy's and St Thomas' NHS Foundation Trust and Evelina London Children's Hospital, London, England
| | - Mohit M Kumar
- Spinal Unit, Department of Orthopaedic Surgery, Guy's and St Thomas' NHS Foundation Trust and Evelina London Children's Hospital, London, England
| | - Erlick A C Pereira
- Spinal Unit, Department of Orthopaedic Surgery, Guy's and St Thomas' NHS Foundation Trust and Evelina London Children's Hospital, London, England; Academic Neurosurgery Unit, St George's Hospital, University of London, London, England
| | - Jonathan D Lucas
- Spinal Unit, Department of Orthopaedic Surgery, Guy's and St Thomas' NHS Foundation Trust and Evelina London Children's Hospital, London, England
| |
Collapse
|
11
|
Severe adolescent idiopathic scoliosis: posterior staged correction using a temporary magnetically-controlled growing rod. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:2046-2053. [PMID: 32506163 DOI: 10.1007/s00586-020-06483-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/14/2020] [Accepted: 05/27/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE A two-staged posterior correction, using a temporary magnetically controlled growing rod (MCGR), was employed to gradually and safely correct severe adolescent idiopathic scoliosis (AIS). The aim of the study is illustrating the results of this procedure. METHODS A retrospective review of a consecutive series of 17 severe AIS. The first surgery was a posterior release (multiple Ponte osteotomies) with implant of pedicle screws and MCGR on the concave side of the curve. In post-operative days, a distraction was applied with MCGR, which allowed to obtain a total mean lengthening of 2 cm in about 2 weeks, with no complications arising. In the second posterior surgery, MCGR was removed and the definitive rods were applied for final fusion. The mean pedicle screws density was 93.3% (85-100). The extension of the final posterior fusion-instrumentation was of 13.8 levels (12-15). RESULTS At an average follow-up (FU) of 2.9 years, the main scoliosis curves from average pre-operative Cobb angle of 98.2° (91°-138°) bent down to 38.3° (35°-76°) after definitive fusion (p < 0.05); at last FU, the overall correction was 58.7% (50.4-71.2), with an average correction loss of 2.1° (1.5°-3.1°). At last FU, no complications were reported. CONCLUSIONS Gradual traction with MCGR in severe AIS proved to be a safe method to achieve progressive curve correction before posterior final fusion, with no neurologic complications associated to more aggressive one-stage surgeries. In a staged approach, MCGR appears as an alternative to halo traction, avoiding frequent traction-related complications.
Collapse
|
12
|
Sun K, Hu H, Gao L, Huang D, Yang T, Hao D. Perioperative Halo-Gravity Traction in the Treatment of Scoliosis with Intraspinal Anomalies. World Neurosurg 2020; 140:e219-e224. [PMID: 32407918 DOI: 10.1016/j.wneu.2020.04.242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the efficacy and safety of preoperative halo-gravity traction and 1-stage posterior surgery for the treatment of scoliosis with intramedullary anomalies. METHODS A total of 11 patients with scoliosis with intramedullary anomalies were evaluated. All patients were treated with preoperative halo-gravity traction and 1-stage posterior surgery. The average age was 11.4 years (range, 7-21 years). All patients were followed-up for at least 2 years (mean, 3.5 years; range, 2-5 years). Their radiologic presentations and complications were reviewed. RESULTS The operating time was 7.9 hours, and the intraoperative bleeding amount was 1890 mL. Both the Cobb angle of scoliosis and kyphosis were significantly improved after halo-gravity traction and the operation (P < 0.05). Tethered cords were released, and intraspinal masses (neurofibromatosis and lipoma) were excised. Syringomyelia and split spinal cord malformations were left untreated. None of the patients experienced deterioration in their neurologic status after surgery. No severe complications, such as infection, cerebrospinal fluid leakage, failed internal fixation, or fractured pedicle screws or rods occurred after the operation. There was no deterioration of neurologic function, delayed infection, or pseudoarthrosis during the follow-up visits. CONCLUSIONS Preoperative halo-gravity traction and 1-stage posterior surgery provided patients who had scoliosis and intramedullary anomalies an effective and safe treatment option with few complications.
Collapse
Affiliation(s)
- Kai Sun
- Department of Spinal Surgery, HongHui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Huimin Hu
- Department of Spinal Surgery, HongHui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Lin Gao
- Department of Spinal Surgery, HongHui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Dageng Huang
- Department of Spinal Surgery, HongHui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Tong Yang
- Department of Spinal Surgery, HongHui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Dingjun Hao
- Department of Spinal Surgery, HongHui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China.
| |
Collapse
|
13
|
Is the Risk of Aorta Injury or Impingement Higher During Correction Surgery in Patients with Severe and Rigid Scoliosis? World Neurosurg 2020; 139:e626-e634. [PMID: 32339734 DOI: 10.1016/j.wneu.2020.04.065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the position of the aorta relative to the spine and the risk of aortic injury during correction surgery in patients with idiopathic severe and rigid scoliosis (main curve Cobb angle >90° and flexibility <30%). METHODS Twenty-seven patients with severe right thoracic/thoracolumbar scoliosis were recruited. The entry point-aorta distance (EAD), the left pedicle-aorta angle (α), the left aorta angle (β), and the vertebral rotation angle (γ) were measured from 4 vertebrae above (A4) to 4 below (B4) the apical vertebra (Apex) to quantify the spatial relationship between aorta and spine. We simulated the pedicle screw misplacement with variable direction error, length, and diameter to analyze the potential risk of aortic injury. RESULTS The aorta shifted laterally and posteriorly as it descended from A4 and moved back medially and anteriorly from Apex. The potential risk of aortic injury increased with the augment of direction error and/or length of the screw, but the tendency was not significant with the augment of diameter. The risk peaked at A4, A3, and B2, when the screw length was 40 mm and diameter was 5.0 mm, and the direction error was 30°, whereas the risk was lowest at the apical level 14.3% (0%-40.7%) in any scenarios. CONCLUSIONS In patients with severe and rigid scoliosis, the aorta shifted more laterally and posteriorly, and the injury risk was lower at the apical level, compared with moderate scoliosis. Most potential risks can be minimized by careful preoperative planning and the assistance of intraoperative navigation or robotics.
Collapse
|
14
|
Establishing Consensus on the Best Practice Guidelines for Use of Halo Gravity Traction for Pediatric Spinal Deformity. J Pediatr Orthop 2020; 40:e42-e48. [PMID: 30994582 DOI: 10.1097/bpo.0000000000001379] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although halo gravity traction (HGT) has been used to treat children with severe spinal deformity for decades, there is a distinct lack of high-quality evidence to speak to its merits or to dictate ideal manner of implementation. In addition, no guidelines exist to drive research or assist surgeons in their practice. The aim of this study was to establish best practice guidelines (BPG) using formal techniques of consensus building among a group of experienced pediatric spinal deformity surgeons to determine ideal indications and implementation of HGT for pediatric spinal deformity. METHODS The Delphi process and nominal group technique were used to formally derive consensus among leaders in pediatric spine surgery. Initial work identified significant areas of variability in practice for which we sought to garner consensus. After review of the literature, 3 iterative surveys were administered from February through April 2018 to nationwide experts in pediatric spinal deformity. Surveys assessed anonymous opinions on ideal practices for indications, preoperative evaluation, protocols, and complications, with agreement of 80% or higher considered consensus. Final determination of consensus items and equipoise were established using the Nominal group technique in a facilitated meeting. RESULTS Of the 42 surgeons invited, responses were received from 32, 40, and 31 surgeons for each survey, respectively. The final meeting included 14 experts with an average 10.5 years in practice and average 88 annual spinal deformity cases. Experts reached consensus on 67 items [indications (17), goals (1), preoperative evaluations (5), protocols (36), complications (8)]; these were consolidated to create final BPG in all categories, including statements to help dictate practice such as using at least 6 to 8 pins under 4 to 8 lbs of torque, with a small, tolerable starting weight and reaching goal weight of 50% TBW in ∼2 weeks. Nine items remained items of equipoise for the purposes of guiding future research. CONCLUSIONS We developed consensus-based BPG for the use and implementation of HGT for pediatric spinal deformity. This can serve as a measure to help drive future research as well as give new surgeons a place to begin their practice of HGT. LEVEL OF EVIDENCE Level V-expert opinion.
Collapse
|
15
|
Mejabi JO, Sergeenko OM, Ryabykh SO. Correction using Halo Gravity Traction for Severe Rigid Neuromuscular Scoliosis: A Report of Three Cases. Malays Orthop J 2019; 13:49-53. [PMID: 31001385 PMCID: PMC6459033 DOI: 10.5704/moj.1903.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Severe rigid neuromuscular scoliosis is a major challenge to the spine surgeon due to the possibilities of neurological sequelae from acute correction of the deformity. Halo gravity traction has been considered as a way of reducing the deformity before correction to prevent neurological complications. Three female patients with severe neuromuscular scoliosis aged seven to 13 years with main coronal Cobb angle of 95°-128° and Kyphotic Cobb of 47°-118° having ≤35% flexibility on traction, had between 18 to 23 days of 16 hour/day of halo gravity traction and night time supine traction with 4kg weight for 7-8 hours. They had 28.9% and 18.5% of main coronal and kyphotic Cobb angle correction post-traction respectively. All had posterior instrumentation and post-operatively, they had correction of main coronal Cobb angle of 29°-58° and kyphotic Cobb angle of 30°-77° with no neurological complication. Halo gravity traction is therefore a viable option for reducing post-operative neurological complication in rigid severe scoliosis.
Collapse
Affiliation(s)
- J O Mejabi
- Department of Surgery, Federal Medical Centre, Birnin Kebbi, Nigeria.,Department of Orthopaedics, Russian Ilizarov Scientific Center, Kurgan, Russia
| | - O M Sergeenko
- Department of Orthopaedics, Russian Ilizarov Scientific Center, Kurgan, Russia
| | - S O Ryabykh
- Department of Orthopaedics, Russian Ilizarov Scientific Center, Kurgan, Russia
| |
Collapse
|
16
|
Surgical treatment for severe and rigid scoliosis: a case-matched study between idiopathic scoliosis and syringomyelia-associated scoliosis. Spine J 2019; 19:87-94. [PMID: 29800706 DOI: 10.1016/j.spinee.2018.05.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 05/15/2018] [Accepted: 05/17/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Treatment guidelines for severe and rigid syringomyelia-associated scoliosis (SRSMS) are limited. Typically, surgeons apply practice guidelines for severe and rigid idiopathic scoliosis (SRIS) to treat SRSMS. No study has directly compared the results of surgical treatment between patients with SRSMS and those with SRIS. PURPOSE The present study was performed to compare the outcomes of surgical correction of SRSMS and SRIS from clinical and radiographic perspectives. STUDY DESIGN This is a retrospective, case-matched, single-center, institutional review board-approved study. PATIENT SAMPLE A total of 26 patients with SRSMS or SRIS treated by an anterior and posterior vertebral column resection approach or an internal distraction approach were enrolled. OUTCOME MEASURES The SRSMS and SRIS groups were compared on the following variables: fusion length, screw number, operation time, estimated blood loss, follow-up duration, different radiological parameters (including main thoracic curve, cranial compensatory curve, caudal compensatory curve, thoracic kyphosis, lumbar lordosis, thoracic apical vertebral translation, coronal balance, and sagittal vertical axis), Scoliosis Research Society (SRS)-22 scores, and complication rate. METHODS Thirteen patients with SRSMS were matched with patients with SRIS on curve magnitude, the flexibility of the main curve, surgical procedure, age, and gender. All patients had a minimum of 2 years of follow-up. The radiographic parameters and demographic data from patients were evaluated before surgery, immediately after surgery, and at the latest follow-up. RESULTS The case matches were relatively ideal except one pair with the main curve in the opposite direction. There was no significant difference in fusion length, screw number, operation time, estimated blood loss, or follow-up duration between the two groups. No significant differences were found between the two groups in the main curve or caudal compensatory curve before surgery, immediately after the operation, or at the final follow-up. The correction of thoracic apical vertebral translation in the SRIS group was better than that in the SRSMS group. The SRSMS group had a larger preoperative, postoperative, and final follow-up cranial compensatory curve and a lower correction rate than did the SRIS group. There was no significant difference in preoperative coronal balance between the two groups. After surgery, the coronal balance in the SRSMS and SRIS groups averaged 24.4±13.2 mm and 12.1±7.9 mm, respectively, which was significantly different (p=.04). At the most recent follow-up, the coronal balance in the SRSMS group improved to 14.8±12.6 mm, and it was 11.8±8.6 mm in the SRIS group. No significant difference was found between the two groups (p=.56). There was no significant difference in thoracic kyphosis, lumbar lordosis, or sagittal vertical axis before surgery, immediately after the operation, or at the final follow-up. Before surgery and at the final follow-up, the two groups had similar scores on function, pain, self-image, mental health, and satisfaction. There was no significant difference in complication rates between the two groups. CONCLUSIONS Typically, surgical correction outcomes are similar in patients with SRSMS and SRIS. Patients with SRIS tended to have a smaller cranial compensatory curve and better correction of the cranial compensatory curve and thoracic apical vertebral translation. Patients with SRSMS tended to have a higher proportion and greater amount of postoperative coronal imbalance, which may be improved during follow-up.
Collapse
|
17
|
Solla F, Clément JL, Doria C, Bertoncelli C, Rosello O, Rampal V. Adolescent idiopathic scoliosis exceeding 70°: a single unit surgical experience. ACTA ACUST UNITED AC 2018. [DOI: 10.23736/s0394-3410.18.03881-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
18
|
Qiao J, Xiao L, Xu L, Liu Z, Sun X, Qian B, Zhu Z, Qiu Y. Skull-femoral traction after posterior release for correction of adult severe scoliosis: efficacy and complications. BMC Musculoskelet Disord 2018; 19:277. [PMID: 30068340 PMCID: PMC6090980 DOI: 10.1186/s12891-018-2207-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 07/24/2018] [Indexed: 11/10/2022] Open
Abstract
Background It is a great challenge for spine surgeons to correct severe rigid scoliosis. We developed a three- staged correction (one stage posterior release and screw placement, two stage skull-femoral traction and three stage posterior instrumentation) for adult severe scoliosis. The objective of this study is to investigate safety and efficacy of a three- staged correction for adult severe scoliosis. Methods A retrospective review was performed for patients with severe scoliosis receiving three- staged correction (one stage posterior release and screw placement, two stage skull-femoral traction and three stage posterior instrumentation) from June 2001 to October 2014. The inclusion criteria were as follows: [1] age more than 18 years; [2] main curve larger than 90°; [3] a minimum 2-year follow-up. Patients were excluded if they had a history of surgery or anterior release or receiving three column osteotomies. Results A total of 63 patients were included (37 female and 26 male), with a mean age of 22.7 years (range: 18–30 years) and follow-up of 42.6 months (range: 24–108 months). The aetiology was congenital in 27 patients, neuromuscular in 18, idiopathic in 11, neurofibromatosis-1 in 4 and Marfan syndrome in 3. The mean traction weight was 28.4 kg (range: 18–32 kg), equal to 57.2% of patients’ body weight (range: 42.7–72.3%). The mean traction time was 22.7 days (range: 12–44 days). Postoperative correction rate was 55% (range: 38–78%) for scoliosis and 51% (range: 32–75%) for kyphosis. Contribution of traction to correction was 51% (range: 36–70%) for scoliosis and was 43% (range: 34–55%) for kyphosis. Conclusions Three- staged correction (one stage posterior release and screw placement, two stage skull-femoral traction and three stage posterior instrumentation) could effectively correct adult severe scoliosis. The incidence of complications of skull-femoral traction was not low, but transient and could be successfully managed.
Collapse
Affiliation(s)
- Jun Qiao
- Department of Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, China
| | - Lingyan Xiao
- Intensive care unit, the Second Hospital of Nanjing, Southeast University, Nanjing, China
| | - Leilei Xu
- Department of Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, China
| | - Zhen Liu
- Department of Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, China
| | - Xu Sun
- Department of Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, China
| | - Bangping Qian
- Department of Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, China
| | - Zezhang Zhu
- Department of Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, China.
| | - Yong Qiu
- Department of Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, China
| |
Collapse
|
19
|
Surgical correction of severe spinal deformities using a staged protocol of external and internal techniques. INTERNATIONAL ORTHOPAEDICS 2017; 42:331-338. [PMID: 29264644 DOI: 10.1007/s00264-017-3738-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 12/13/2017] [Indexed: 01/27/2023]
Abstract
INTRODUCTION There is high risk of neurologic complications in one-stage management of severe rigid spinal deformities in adolescents. Therefore, gradual spine stretching variants are applied. One of them is the use of external transpedicular fixation. PURPOSE Our aim was to retrospectively study the outcomes of gradual correction with an apparatus for external transpedicular fixation followed by internal fixation used for high-grade kyphoscoliosis in adolescents. METHODS Twenty five patients were reviewed (mean age, 15.1 ± 0.4 years). Correction was performed in two stages: 1) gradual controlled correction with the apparatus for external transpedicular fixation; and 2) internal posterior transpedicular fixation. Rigid deformities in eight patients required discapophysectomy. Clinical and radiographic study of the outcomes was conducted immediately after treatment and at a mean long-term period of 3.8 ± 0.4 years. Pain was evaluated using the visual analogue scale (VAS, 10 points). The Oswestry questionnaire (ODI scale) was used for functional assessment. RESULTS Deformity correction with the external apparatus was 64.2 ± 4.6% in the main curve and 60.7 ± 3.7% in the compensatory one. It was 72.8 ± 4.1% and 66.2 ± 5.3% immediately after treatment and 70.8 ± 4.6% and 64.3 ± 4.2% at long term, respectively. Pain relieved by 33.2 ± 4.2% (p < 0.05) immediately after treatment and by 55.6 ± 2.8% (p < 0.05) at long term. ODI reduced by 30.2 ± 1.7% (p < 0.05) immediately after treatment and by 37.2 ± 1.6% (p < 0.05) at long term. CONCLUSION The apparatus for external transpedicular fixation provides gradual controlled correction for high-grade kyphoscoliosis in adolescents. Transition to internal fixation preserves the correction achieved, and correction is maintained at long term.
Collapse
|
20
|
Abstract
Correction manoeuvres are as important as the other issues such as hardware selection, graft options, fusion and osteotomy techniques in the surgical treatment of spinal deformities.The property of materials demonstrating both viscous and elastic characteristics when undergoing deformation is called visco-elasticity. Purely elastic materials change in shape with a stress, and go back to their initial form when the stress is removed. However, visco-elastic materials, like the spine, may protect their new formation unless a back stress is applied. Time is a very important parameter during manoeuvre application to the spine because of its visco-elastic behavior.The most common correction manoeuvres that can be used for spinal deformities are rod de-rotation, distraction-compression, in situ rod bending, segmental de-rotation, en bloc de-rotation and cantilever.Spontaneous correction of a minor curve is possible after selective fusion of a major curve due to coupling phenomenon. Cite this article: EFORT Open Rev 2017;2. DOI: 10.1302/2058-5241.2.170002. Originally published online at www.efortopenreviews.org.
Collapse
Affiliation(s)
| | - Mehmet Cetinkaya
- Erzincan University, Mengucek Gazi Education and Research Hospital, Erzincan, Turkey
| |
Collapse
|
21
|
Yang C, Wang H, Zheng Z, Zhang Z, Wang J, Liu H, Kim YJ, Cho S. Halo-gravity traction in the treatment of severe spinal deformity: a systematic review and meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 26:1810-1816. [PMID: 27858237 DOI: 10.1007/s00586-016-4848-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 06/11/2016] [Accepted: 10/25/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Halo-gravity traction has been reported to successfully assist in managing severe spinal deformity. This is a systematic review of all studies on halo-gravity traction in the treatment of spinal deformity to provide information for clinical practice. METHODS A comprehensive search was conducted for articles on halo-gravity traction in the treatment of spinal deformity according to the PRISMA guidelines. Appropriate studies would be included and analyzed. Preoperative correction rate of spinal deformity, change of pulmonary function and prevalence of complications were the main measurements. RESULTS Sixteen studies, a total of 351 patients, were included in this review. Generally, the initial Cobb angle was 101.1° in the coronal plane and 80.5° in the sagittal plane, and it was corrected to 49.4° and 56.0° after final spinal fusion. The preoperative correction due to traction alone was 24.1 and 19.3%, respectively. With traction, the flexibility improved 6.1% but postoperatively the patients did not have better correction. Less aggressive procedures and improved pulmonary function were observed in patients with traction. The prevalence of traction-related complications was 22% and three cases of neurologic complication related to traction were noted. The prevalence of total complications related to surgery was 32% and that of neurologic complications was 1%. CONCLUSION Partial correction could be achieved preoperatively with halo-gravity traction, and it may help decrease aggressive procedures, improve preoperative pulmonary function, and reduce neurologic complications. However, traction could not increase preoperative flexibility or final correction. Traction-related complications, although usually not severe, were not rare.
Collapse
Affiliation(s)
- Changsheng Yang
- Department of Orthopedic Surgery, Guangdong Orthopedic Hospital (The Third Affiliated Hospital of Southern Medical University), Guangzhou, 510000, China
| | - Huafeng Wang
- Department of Spine Surgery, Fuzhou Second Hospital, Xiamen University, Fuzhou, 350007, China
| | - Zhaomin Zheng
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, China.
| | - Zhongmin Zhang
- Department of Orthopedic Surgery, Guangdong Orthopedic Hospital (The Third Affiliated Hospital of Southern Medical University), Guangzhou, 510000, China
| | - Jianru Wang
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, China.
| | - Hui Liu
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Yongjung Jay Kim
- Department of Orthopaedic Surgery, College of Physicians and Surgeons, Columbia University, 622 West 168th Street PH-11, New York, NY, 10032, USA
| | - Samuel Cho
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, Box 1188, New York, NY, 10029, USA
| |
Collapse
|
22
|
Wang JH, Daniels AH, Palumbo MA, Eberson CP. Cervical Traction for the Treatment of Spinal Injury and Deformity. JBJS Rev 2016; 2:01874474-201405000-00004. [PMID: 27500609 DOI: 10.2106/jbjs.rvw.m.00108] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Joanne H Wang
- Hasbro Children's Hospital, 2 Dudley Street, Suite 200, Providence, RI, 02903
| | | | | | | |
Collapse
|
23
|
Bao H, Yan P, Bao M, Qiu Y, Zhu Z, Liu Z, Cheng JCY, Ng BKW, Zhu F. Halo-gravity traction combined with assisted ventilation: an effective pre-operative management for severe adult scoliosis complicated with respiratory dysfunction. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 25:2416-22. [DOI: 10.1007/s00586-016-4607-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 05/04/2016] [Accepted: 05/05/2016] [Indexed: 01/10/2023]
|
24
|
Cimic M, Crnogaca K, Vrdoljak O, Bicanic G. Halogravity traction in the preoperative treatment of scoliosis in twins with Marfan syndrome. BMJ Case Rep 2015; 2015:bcr-2014-209281. [PMID: 26032703 DOI: 10.1136/bcr-2014-209281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report on the influence of the duration of halogravity traction for achieving curve correction in monozygotic twins with Marfan syndrome who underwent posterior spinal fusion. Review of the medical charts and standard radiograph analysis of twin girls treated at our department was performed. Halogravity traction with a four-pin skull construct was applied for 3 weeks in twin A and for 2 weeks in twin B with a maximum of 20% body weight used. Both were on a 24-hours-day halogravity traction regime. Achieved thoracic curve correction after halogravity traction was 31% in twin A and 18% in twin B. Although less curve correction after traction was achieved in twin B, this had no significant implications on final postoperative curve correction. Halogravity traction can be a useful tool in the preoperative treatment of scoliosis in patients with Marfan syndrome if applied for 3 weeks. In order to avoid complications, we propose that lower weights be used with a starting weight of 1.5 kg increased by 1 kg daily until 20% body weight is reached.
Collapse
Affiliation(s)
- Mislav Cimic
- Department of Orthopaedic Surgery, University of Zagreb School of Medicine, Clinical Hospital Centre Zagreb, Zagreb, Croatia
| | - Kresimir Crnogaca
- Department of Orthopaedic Surgery, University of Zagreb School of Medicine, Clinical Hospital Centre Zagreb, Zagreb, Croatia
| | - Ozren Vrdoljak
- Department of Orthopaedic Surgery, University of Zagreb School of Medicine, Clinical Hospital Centre Zagreb, Zagreb, Croatia
| | - Goran Bicanic
- Department of Orthopaedic Surgery, University of Zagreb School of Medicine, Clinical Hospital Centre Zagreb, Zagreb, Croatia
| |
Collapse
|
25
|
Posterior vertebral column resection in spinal deformity: a systematic review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 25:2368-75. [DOI: 10.1007/s00586-015-3767-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 01/10/2015] [Accepted: 01/11/2015] [Indexed: 11/25/2022]
|
26
|
Wang Y, Xie J, Zhao Z, Li T, Zhang Y, Bi N, Shi Z, Cai Y, Zhang Y. Preoperative short-term traction prior to posterior vertebral column resection: procedure and role. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 25:687-97. [PMID: 25575856 DOI: 10.1007/s00586-014-3752-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 12/30/2014] [Accepted: 12/30/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Severe rigid spine deformity with sharp curve can be effectively corrected by posterior vertebral column resection (PVCR). Meanwhile, high risk of this procedure also has been recognized generally. The aim of this study is to review and evaluate the role of preoperative skull-femoral traction prior to PVCR for extremely severe rigid spinal deformity with sharp angular curve >150°. METHODS Twelve cases with extremely severe rigid deformities and sharp curves were treated by skull-femoral traction before operation. For them, the mean preoperative major scoliotic curve and kyphosis were 153° (110°-168°) and 109° (61°-180°). Continuous skull-femoral traction in supine position was started 4 weeks before operation. In the process of traction, tolerance, neurologic status, deformity changes, etc., were reviewed and documented for analysis. PVCR were performed in all these patients for final and main correction. RESULTS The final traction force in the 12 cases was 63% of body weight. After 4-week traction, the main scoliotic curve and kyphosis were decreased by 34 and 31%. In 1 week, main scoliotic curve and kyphosis were decreased by 19 and 15%. In 2 weeks, the major scoliosis curve was decreased by 11%, but kyphosis was unexpectedly increased by 4%. Deformity in the last 2 weeks was less significant than the first 2 weeks. After PVCR, the main scoliotic curve and kyphosis were improved 69 and 66%. No permanent neurological damage occurred. CONCLUSION Preoperative skull-femoral traction effectively mitigates the neurological risks of PVCR for extremely severe rigid spinal deformity with sharp curve. During traction, scoliosis can be improved more significantly and easily than kyphosis.
Collapse
Affiliation(s)
- Yingsong Wang
- Department of Orthopaedics, The 2nd Affiliated Hospital of Kunming Medical University, 374# Dianmian Road, Kunming, 650101, Yunnan, People's Republic of China
| | - Jingming Xie
- Department of Orthopaedics, The 2nd Affiliated Hospital of Kunming Medical University, 374# Dianmian Road, Kunming, 650101, Yunnan, People's Republic of China.
| | - Zhi Zhao
- Department of Orthopaedics, The 2nd Affiliated Hospital of Kunming Medical University, 374# Dianmian Road, Kunming, 650101, Yunnan, People's Republic of China
| | - Tao Li
- Department of Orthopaedics, The 2nd Affiliated Hospital of Kunming Medical University, 374# Dianmian Road, Kunming, 650101, Yunnan, People's Republic of China
| | - Yin Zhang
- Department of Orthopaedics, The 2nd Affiliated Hospital of Kunming Medical University, 374# Dianmian Road, Kunming, 650101, Yunnan, People's Republic of China
| | - Ni Bi
- Department of Orthopaedics, The 2nd Affiliated Hospital of Kunming Medical University, 374# Dianmian Road, Kunming, 650101, Yunnan, People's Republic of China
| | - Zhiyue Shi
- Department of Orthopaedics, The 2nd Affiliated Hospital of Kunming Medical University, 374# Dianmian Road, Kunming, 650101, Yunnan, People's Republic of China
| | - Yunhua Cai
- Department of Orthopaedics, The 2nd Affiliated Hospital of Kunming Medical University, 374# Dianmian Road, Kunming, 650101, Yunnan, People's Republic of China
| | - Yuhao Zhang
- Department of Orthopaedics, The 2nd Affiliated Hospital of Kunming Medical University, 374# Dianmian Road, Kunming, 650101, Yunnan, People's Republic of China
| |
Collapse
|
27
|
Ren C, Liu L, Song Y, Zhou C, Liu H, Li T. Comparison of anterior and posterior vertebral column resection versus anterior release with posterior internal distraction for severe and rigid scoliosis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 23:1237-43. [PMID: 24647597 DOI: 10.1007/s00586-014-3270-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 03/08/2014] [Accepted: 03/08/2014] [Indexed: 02/05/2023]
Abstract
PURPOSE This study aimed to compare efficacy, safety, and cost between staged vertebral column resection (VCR) and anterior release with internal distraction in treating severe and rigid idiopathic scoliosis. METHODS We examined the records of 43 patients with severe and rigid idiopathic scoliosis treated in our hospital. Group A included 26 patients who underwent anterior VCR followed by posterior vertebral column resection and instrumentation from July 2007 to October 2009. Group B included 17 patients who underwent anterior release with temporary posterior internal distraction, followed by posterior fusion and instrumentation from November 2009 to June 2011. The average preoperative main curve for group A was 101.3° (range 90°-130°) and for group B was 104.8° (range 90°-136°). Minimum follow-up was 2 years. Radiographic and clinical outcomes were compared between the groups. RESULTS A t test demonstrated that the differences between the groups in preoperative and postoperative coronal and sagittal imbalance, thoracic kyphosis correction, and lumbar lordosis were not statistically significant. Patients in group B showed better postoperative (P = 0.031) and final (P = 0.030) main thoracic curve correction (76.8 and 75.6 %, respectively) than patients in group A (68.3 and 67.7 %, respectively). Patients in group B had better thoracolumbar or lumbar curve correction (85.8 %) than those in group A (76.8 %; P = 0.048). The differences in blood loss and operation time were not statistically significant (P = 0.094 and P = 0.060, respectively). Hospital stay was longer (P = 0.001) and patient cost was higher (P < 0.001) for patients in group B. One patient in group A required ventilator support for 12 h after anterior surgery. One transient dyspnea occurred in group B. No neurologic deficits occurred in either group. CONCLUSION Anterior release with posterior internal distraction produces better corrective effects than anterior and posterior VCR, though hospital stay and costs are greater.
Collapse
Affiliation(s)
- Chunpeng Ren
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, 37 Guoxue Rd, Chengdu, 610041, People's Republic of China,
| | | | | | | | | | | |
Collapse
|
28
|
Hui H, Zhang ZX, Yang TM, He BR, Hao DJ. Vertebral column resection for complex congenital kyphoscoliosis and type I split spinal cord malformation. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 23:1158-63. [PMID: 24232596 DOI: 10.1007/s00586-013-3044-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 09/12/2013] [Accepted: 09/24/2013] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Congenital progressive kyphoscoliosis associated with split spinal cord malformation (SSCM) is a very rare disease. METHODS AND RESULTS Here, we present the case of a 23-year-old woman who was found kyphoscoliosis when she was 10 years old and developed rapidly. Thereafter, no management was proposed before her consultation at our center. On examination, numbness was found in the right low limbs, kyphoscoliosis was detected in thoracolumbar, the trunk deviated to the right on standing view and curvature of the thoracolumbar spine was left-sided, the left rib hump was severe and there was little muscle tissue felt under the right side paravertebral area, the pelvis was oblique with the right side higher than the left side, the right arcus costarum was 5 cm below the right iliac crest. One-stage corrective surgery was determined, at first, halo-wheelchair traction gradually with increased traction weights out of hospital for a month; then, after a reasonable correction achieved without any neurological deficits. The one-stage operation was taken through single posterior segmental pedicle screw instrumented fusion with VCR between T12 and L1. Post-operative recovery was uneventful and there were no complications, she was discharged 10 days post operation. At 2 years follow-up, the patient's outcome is excellent with balance and correction of the deformity. CONCLUSION Based on the Grand Round case and relevant literature, we discuss the different options for the treatment of congenital kyphoscoliosis associated with type I SSCM. In the patient whose kyphoscoliosis is severe and rigid, we recommend an initial release followed by halo-wheelchair traction gradually to correct the deformity, once optimal correction acquires during the traction, the posterior instrumented fusion with VCR upper the bony spur could be done safely without the resection of bony spur.
Collapse
|
29
|
Intraoperative skull-femoral (skeletal) traction in surgical correction of severe scoliosis (>80°) in adult neglected scoliosis. Spine (Phila Pa 1976) 2013; 38:659-64. [PMID: 23060059 DOI: 10.1097/brs.0b013e318277c874] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective review. OBJECTIVE To evaluate the effectiveness, safety, and reliability of intraoperative skeletal traction in the surgical correction of severe adult neglected scoliosis. SUMMARY OF BACKGROUND DATA Literature shows that curves more than 80° that do not reduce to 50° to 55° on bending radiographs require an anterior release. A combined anterior and posterior approach is often used for treating severe rigid scoliosis. However, anterior approach has its own complications in the form of increased morbidity, increased blood loss, operative time, and pulmonary complications. Corrective surgery gets even more challenging if the patients are adults. METHODS Ten patients with severe scoliosis (>80°) and low flexibility index (<0.5) treated with intraoperative skeletal traction were part of this study. The patients were operated between April 2008 and May 2010. Eight patients with neglected adolescent idiopathic scoliosis and 2 with neuromuscular scoliosis were included. The mean age was 27.4 years (19-36). Corrective surgery and fusion was performed using intraoperative skeletal traction. RESULTS The Cobb angle improved from a mean of 89.35° preoperatively to 40.25° postoperatively giving a mean correction of 55.29%. Apical vertebral rotation (Nash and Moe) improved from a mean of grade 3(2-4) to a mean of grade 2(1-3). Apical vertebral translation improved from a mean of 2.19 cm preoperatively to 0.98 cm postoperatively (55.41% correction). There were no intraoperative adverse events or postoperative complications. All patients had good shoulder balance and were satisfied with the correction achieved. CONCLUSION Intraoperative skull-femoral traction can be a safe and effective method to assist correction of severe and rigid scoliosis. It facilitates surgical exposure and pedicle screw insertion. It obviates the need of an anterior release surgery and associated morbidity, thus reducing the hospital stay and costs. It provides a much simpler way to correct the sagittal and coronal imbalance, as well as the pelvic obliquity.
Collapse
|
30
|
Levin LS, Arlet V. Expert's comment concerning Grand Rounds case entitled "Staged corrective surgery for complex adolescent kyphoscoliosis caused by back scalding during the childhood period" (by Hui-Ren Tao et al. doi:10.1007/s00586-012-2519-1). EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2012; 22:310-2. [PMID: 23212649 DOI: 10.1007/s00586-012-2579-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/04/2012] [Indexed: 11/29/2022]
|
31
|
Staged corrective surgery for complex adolescent kyphoscoliosis caused by back scalding during the childhood period. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2012; 22:305-9. [PMID: 23053756 DOI: 10.1007/s00586-012-2519-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Revised: 07/25/2012] [Accepted: 09/18/2012] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Adolescent scar contracture kyphoscoliosis is a very rare disease. METHODS AND RESULTS Here, we present the case of a 21-year-old man who was scalded due to ebullient water when he was 10 years old. Moreover, kyphoscoliosis was found when he was 12 years old and developed rapidly. Thereafter, no management was proposed before his consultation at our center. On examination, kyphoscoliosis was detected in thoracolumbar, the trunk deviated to the right on standing view, extensive contractured scar presented on the right side of the back, abdomen, chest wall, hip, right thighs and armpit anterior, especially in the right flank. A one-stage correction was deemed too risky, we therefore released contractured scar during the first stage with the defect of soft tissue protected by vacuum sealing drainage and then performed skeletal traction with halo and bilateral femoral pins. A reasonable correction was achieved without any neurological deficits 1 month after traction. Next, a second-stage operation was taken to translate a free anterolateral thigh myocutaneous flap to overlay the extensive defect of soft tissue. 1.5 months later, a third posterior segmental pedicle screw instrumented fusion with Smith-Peterson osteotomy between T9 and L2 was performed. Postoperative recovery was uneventful and as there were no complications, he was discharged 10 days after the third surgery. At 2-year follow-up the patient's outcome is excellent with balance and correction of the deformity. CONCLUSION Based this grand round case and relevant literature, we discuss the different options for the treatment of adolescent scar contracture scoliosis.
Collapse
|