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Stuedemann A, Huston M, Saddler N, Schwend RM, Anderson J, Pierce E, Koivuniemi-Berg T, Fryatt J, Herman K. Implementing a Halo Gravity Traction Program: A Multidisciplinary Endeavor. Orthop Nurs 2024; 43:202-211. [PMID: 39047271 DOI: 10.1097/nor.0000000000001040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2024] Open
Abstract
Halo gravity traction (HGT) is a preoperative modality for children with severe spinal deformity used to optimize spine flexibility and balance while decreasing the likelihood of neurologic injury. HGT is a dependable solution for these challenging spinal deformities. Aligning treatment guidelines and providing resources, education, and training for staff are key components for a successful HGT program. The HGT program at Children's Mercy Hospital was then developed with a systems approach with the holistic goal of multidisciplinary collaboration with physical/occupational therapy, hospital medicine, pulmonology, psychology, nutrition, child life, and complex care management. Education, research, and national collaboration to standardize this therapy should improve patient safety and support quality improvement.
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Affiliation(s)
- Anne Stuedemann
- Anne Stuedemann, MSN, RN, CPNP, Orthopaedic Surgery, Children's Mercy Kansas City, Kansas City, MO
- Michon Huston, PA-C, Children's Mercy Kansas City, Kansas City, MO
- Nicolette Saddler, MSN, APRN, FNP-C, Children's Mercy Kansas City, Kansas City, MO
- Richard M Schwend, MD FAAP FAOA, Children's Mercy Kansas City, Kansas City, MO
- John Anderson, MD, Children's Mercy Kansas City, Kansas City, MO
- Elizabeth Pierce, DPT, Children's Mercy Kansas City, Kansas City, MO
- Tiffany Koivuniemi-Berg, DPT, Children's Mercy Kansas City, Kansas City, MO
- Jamie Fryatt, RN, BSN, CPN, Children's Mercy Kansas City, Kansas City, MO
- Katrina Herman, RN, BSN, CPN, Children's Mercy Kansas City, Kansas City, MO
| | - Michon Huston
- Anne Stuedemann, MSN, RN, CPNP, Orthopaedic Surgery, Children's Mercy Kansas City, Kansas City, MO
- Michon Huston, PA-C, Children's Mercy Kansas City, Kansas City, MO
- Nicolette Saddler, MSN, APRN, FNP-C, Children's Mercy Kansas City, Kansas City, MO
- Richard M Schwend, MD FAAP FAOA, Children's Mercy Kansas City, Kansas City, MO
- John Anderson, MD, Children's Mercy Kansas City, Kansas City, MO
- Elizabeth Pierce, DPT, Children's Mercy Kansas City, Kansas City, MO
- Tiffany Koivuniemi-Berg, DPT, Children's Mercy Kansas City, Kansas City, MO
- Jamie Fryatt, RN, BSN, CPN, Children's Mercy Kansas City, Kansas City, MO
- Katrina Herman, RN, BSN, CPN, Children's Mercy Kansas City, Kansas City, MO
| | - Nicolette Saddler
- Anne Stuedemann, MSN, RN, CPNP, Orthopaedic Surgery, Children's Mercy Kansas City, Kansas City, MO
- Michon Huston, PA-C, Children's Mercy Kansas City, Kansas City, MO
- Nicolette Saddler, MSN, APRN, FNP-C, Children's Mercy Kansas City, Kansas City, MO
- Richard M Schwend, MD FAAP FAOA, Children's Mercy Kansas City, Kansas City, MO
- John Anderson, MD, Children's Mercy Kansas City, Kansas City, MO
- Elizabeth Pierce, DPT, Children's Mercy Kansas City, Kansas City, MO
- Tiffany Koivuniemi-Berg, DPT, Children's Mercy Kansas City, Kansas City, MO
- Jamie Fryatt, RN, BSN, CPN, Children's Mercy Kansas City, Kansas City, MO
- Katrina Herman, RN, BSN, CPN, Children's Mercy Kansas City, Kansas City, MO
| | - Richard M Schwend
- Anne Stuedemann, MSN, RN, CPNP, Orthopaedic Surgery, Children's Mercy Kansas City, Kansas City, MO
- Michon Huston, PA-C, Children's Mercy Kansas City, Kansas City, MO
- Nicolette Saddler, MSN, APRN, FNP-C, Children's Mercy Kansas City, Kansas City, MO
- Richard M Schwend, MD FAAP FAOA, Children's Mercy Kansas City, Kansas City, MO
- John Anderson, MD, Children's Mercy Kansas City, Kansas City, MO
- Elizabeth Pierce, DPT, Children's Mercy Kansas City, Kansas City, MO
- Tiffany Koivuniemi-Berg, DPT, Children's Mercy Kansas City, Kansas City, MO
- Jamie Fryatt, RN, BSN, CPN, Children's Mercy Kansas City, Kansas City, MO
- Katrina Herman, RN, BSN, CPN, Children's Mercy Kansas City, Kansas City, MO
| | - John Anderson
- Anne Stuedemann, MSN, RN, CPNP, Orthopaedic Surgery, Children's Mercy Kansas City, Kansas City, MO
- Michon Huston, PA-C, Children's Mercy Kansas City, Kansas City, MO
- Nicolette Saddler, MSN, APRN, FNP-C, Children's Mercy Kansas City, Kansas City, MO
- Richard M Schwend, MD FAAP FAOA, Children's Mercy Kansas City, Kansas City, MO
- John Anderson, MD, Children's Mercy Kansas City, Kansas City, MO
- Elizabeth Pierce, DPT, Children's Mercy Kansas City, Kansas City, MO
- Tiffany Koivuniemi-Berg, DPT, Children's Mercy Kansas City, Kansas City, MO
- Jamie Fryatt, RN, BSN, CPN, Children's Mercy Kansas City, Kansas City, MO
- Katrina Herman, RN, BSN, CPN, Children's Mercy Kansas City, Kansas City, MO
| | - Elizabeth Pierce
- Anne Stuedemann, MSN, RN, CPNP, Orthopaedic Surgery, Children's Mercy Kansas City, Kansas City, MO
- Michon Huston, PA-C, Children's Mercy Kansas City, Kansas City, MO
- Nicolette Saddler, MSN, APRN, FNP-C, Children's Mercy Kansas City, Kansas City, MO
- Richard M Schwend, MD FAAP FAOA, Children's Mercy Kansas City, Kansas City, MO
- John Anderson, MD, Children's Mercy Kansas City, Kansas City, MO
- Elizabeth Pierce, DPT, Children's Mercy Kansas City, Kansas City, MO
- Tiffany Koivuniemi-Berg, DPT, Children's Mercy Kansas City, Kansas City, MO
- Jamie Fryatt, RN, BSN, CPN, Children's Mercy Kansas City, Kansas City, MO
- Katrina Herman, RN, BSN, CPN, Children's Mercy Kansas City, Kansas City, MO
| | - Tiffany Koivuniemi-Berg
- Anne Stuedemann, MSN, RN, CPNP, Orthopaedic Surgery, Children's Mercy Kansas City, Kansas City, MO
- Michon Huston, PA-C, Children's Mercy Kansas City, Kansas City, MO
- Nicolette Saddler, MSN, APRN, FNP-C, Children's Mercy Kansas City, Kansas City, MO
- Richard M Schwend, MD FAAP FAOA, Children's Mercy Kansas City, Kansas City, MO
- John Anderson, MD, Children's Mercy Kansas City, Kansas City, MO
- Elizabeth Pierce, DPT, Children's Mercy Kansas City, Kansas City, MO
- Tiffany Koivuniemi-Berg, DPT, Children's Mercy Kansas City, Kansas City, MO
- Jamie Fryatt, RN, BSN, CPN, Children's Mercy Kansas City, Kansas City, MO
- Katrina Herman, RN, BSN, CPN, Children's Mercy Kansas City, Kansas City, MO
| | - Jamie Fryatt
- Anne Stuedemann, MSN, RN, CPNP, Orthopaedic Surgery, Children's Mercy Kansas City, Kansas City, MO
- Michon Huston, PA-C, Children's Mercy Kansas City, Kansas City, MO
- Nicolette Saddler, MSN, APRN, FNP-C, Children's Mercy Kansas City, Kansas City, MO
- Richard M Schwend, MD FAAP FAOA, Children's Mercy Kansas City, Kansas City, MO
- John Anderson, MD, Children's Mercy Kansas City, Kansas City, MO
- Elizabeth Pierce, DPT, Children's Mercy Kansas City, Kansas City, MO
- Tiffany Koivuniemi-Berg, DPT, Children's Mercy Kansas City, Kansas City, MO
- Jamie Fryatt, RN, BSN, CPN, Children's Mercy Kansas City, Kansas City, MO
- Katrina Herman, RN, BSN, CPN, Children's Mercy Kansas City, Kansas City, MO
| | - Katrina Herman
- Anne Stuedemann, MSN, RN, CPNP, Orthopaedic Surgery, Children's Mercy Kansas City, Kansas City, MO
- Michon Huston, PA-C, Children's Mercy Kansas City, Kansas City, MO
- Nicolette Saddler, MSN, APRN, FNP-C, Children's Mercy Kansas City, Kansas City, MO
- Richard M Schwend, MD FAAP FAOA, Children's Mercy Kansas City, Kansas City, MO
- John Anderson, MD, Children's Mercy Kansas City, Kansas City, MO
- Elizabeth Pierce, DPT, Children's Mercy Kansas City, Kansas City, MO
- Tiffany Koivuniemi-Berg, DPT, Children's Mercy Kansas City, Kansas City, MO
- Jamie Fryatt, RN, BSN, CPN, Children's Mercy Kansas City, Kansas City, MO
- Katrina Herman, RN, BSN, CPN, Children's Mercy Kansas City, Kansas City, MO
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2
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Grabala P, Galgano MA, Grabala M, Buchowski JM. Radiological and Pulmonary Results of Surgical Treatment of Severe Idiopathic Scoliosis Using Preoperative Halo Gravity Traction Compared with Less Invasive Temporary Internal Distraction in Staged Surgery in Adolescents. J Clin Med 2024; 13:2875. [PMID: 38792417 PMCID: PMC11122294 DOI: 10.3390/jcm13102875] [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: 03/05/2024] [Revised: 05/04/2024] [Accepted: 05/11/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Severe and rigid scoliosis represents a type of spinal deformity characterized by a Cobb angle exceeding 90° and a flexibility of less than 30%. Halo spinal traction remains the established standard for managing severe scoliosis, although alternative approaches such as temporary internal distraction rods and staged surgical correction exist. The primary objective of this investigation was to compare two cohorts of patients treated using these distinct methods to ascertain any divergences in terms of surgical and radiological outcomes, pulmonary function (PF), and quality of life (QoL). Methods: This study encompassed a total of 62 pediatric patients meeting the specified criteria, which included severe idiopathic scoliosis (major Cobb curve >90) and flexibility <30%. Group 1 (G1) underwent surgical intervention involving preoperative Halo gravity traction (HGT) succeeded by posterior spinal fusion (PSF). On the other hand, Group 2 (G2) underwent a two-stage procedure starting with a less invasive temporary internal distraction technique (LITID) prior to PSF. The radiological outcomes, PF, and QoL were documented and assessed over a monitoring period ranging from 2 to 5 years. Results: The average preoperative major curves (MCs) measured 124° and 122° in G1 and G2, respectively (p < 0.426). Initial flexibility, as observed in preoperative bending films, ranged from 18% in G1 to 21% in G2 (p < 0.001). Following the ultimate surgical intervention, the MCs were corrected to 45° and 37.4° in G1 and G2, respectively (p < 0.001). The percentage correction of the MCs was higher in G2 (63% vs. 70% in G1 and G2, respectively), with significant between-group disparities (p < 0.001). The mean preoperative thoracic kyphoses (TKs) were 96.5° in G1 and 92° in G2 (p = 0.782), which were rectified to 45.8° in G1 and 36.2° in G2 (p < 0.001), equating to correction rates of 55% and 60% in the respective groups. Initially, G2 exhibited lower values for the percentage of predicted lung volume (FVC) and predicted FEV1 compared with G1 (49% and 58% vs. 54.5% and 60.8%; N.S.). Nonetheless, both groups demonstrated enhancements in their FVC and FEV1 values over the follow-up period. Conclusions: The surgical management of severe and untreated spinal curvatures in the pediatric and adolescent population can be considered safe, with a tolerable incidence of minor complications. LITID emerges as a method offering improved QoL and pulmonary function, achieving notably substantial average corrections in deformity by 70% in the coronal plane and 60% in the sagittal plane, alongside a mean increase in trunk height of 10.8 cm. Furthermore, a typical reduction of 76% in rib humps and enhancements in respiratory function, as indicated by improvements in 1 s predicted forced expiratory volume (by 25-56%) and forced vital capacity (by 35-65%), were achieved, leading to a clinically and statistically significant enhancement in QoL when evaluated using SRS-22r, without resorting to more radical, high-risk procedures.
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Affiliation(s)
- Pawel Grabala
- Department of Pediatric Orthopedic Surgery and Traumatology, Medical University of Bialystok and Medical University of Bialystok Children’s Clinical Hospital, ul. Waszyngtona 17, 15-274 Bialystok, Poland
- Paley European Institute, Al. Rzeczypospolitej 1, 02-972 Warsaw, Poland
- Department of Neurosurgery with Department of Interventional Neurology, Medical University of Bialystok and Medical University of Bialystok Clinical Hospital, ul. M. Sklodowskiej-Curie 24A, 15-276 Bialystok, Poland
| | - Michael A. Galgano
- Department of Neurosurgery, University of North Carolina, Chapel Hill, NC 27516, USA;
| | - Michal Grabala
- 2nd Clinical Department of General and Gastroenterogical Surgery, Medical University of Bialystok, ul. M. Skłodowskiej-Curie 24a, 15-276 Bialystok, Poland;
| | - Jacob M. Buchowski
- Department of Orthopedic Surgery, Washington University School of Medicine, 660 S Euclid Ave., St. Louis, MO 63110, USA;
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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.
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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
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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.
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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
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Liang M, Cao J, Zhang X, Guo D, Yao Z, Gao R, Bai Y. Safety and effectiveness of halo gravity traction combined with traditional growing rods in severe early-onset scoliosis with neurofibromatosis type 1. J Pediatr Orthop B 2024:01202412-990000000-00188. [PMID: 38375876 DOI: 10.1097/bpb.0000000000001169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
Neurofibromatosis type 1 (NF-1) scoliosis can be difficult to treat without early detection. Correcting deformities while considering long-term growth in early-onset scoliosis (EOS) treatment is important. This study was performed to establish the safety and effectiveness of halo gravity traction (HGT) with traditional growing rods (TGRs) in NF-1 EOS. We retrospectively reviewed a cohort of 15 children (7 boys and 8 girls; mean age, 5.61 years) diagnosed with NF-1 EOS from October 2016 to March 2021. All patients underwent HGT before growing rod implantation. The growing rods were lengthened every 9-12 months, with a follow-up of 2-7 years. Cobb angle, thoracic kyphosis (TK), trunk shift (TS), sagittal vertebral axis and T1-S1 height were measured before operation, after traction, after operation and at last follow-up. Complications were also recorded. Fifteen patients with NF-1 EOS were treated with an average traction weight of 10.00 kg. After 29.20 days of HGT, the Cobb angle improved from 99.10° to 62.60°, TK from 79.33° to 55.04°, TS from 31.05 to 17.71 mm, sagittal vertebral axis from 42.07 to 25.63 mm and T1-S1 height from 27.50 to 29.70 cm (P < 0.05 for all). Postoperatively, compared with post-traction, the Cobb angle was 52.40° (P = 0.002) and TK was 44.54° (P = 0.004). No complications occurred during traction. Growing rod dislocation occurred in one patient and growing rod breakage in one patient. HGT combined with TGRs was well-tolerated and effective for treating severe NF-1 EOS. It significantly corrected the Cobb angle and TK, restored trunk balance, and increased spinal height with few complications.
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Affiliation(s)
- Mingqian Liang
- Department of Orthopedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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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.
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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
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Tan K, Liu C, Zhao Z, Wang S, Liang Y, Yu B, Xiong F. Effectiveness of Halo-Pelvic Traction and Thoracoplasty for Pulmonary Artery Pressure and Cardiopulmonary Function in Patients With Severe Spinal Deformity. Clin Spine Surg 2023; 36:E464-E470. [PMID: 37448187 DOI: 10.1097/bsd.0000000000001496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 06/21/2023] [Indexed: 07/15/2023]
Abstract
STUDY DESIGN Retrospective review. OBJECTIVE To evaluate the effectiveness of halo-pelvic traction and thoracoplasty for pulmonary artery pressure (PAP) and cardiopulmonary function in patients with severe spinal deformity. SUMMARY OF BACKGROUND DATA The effect of severe spinal deformity on pulmonary arterial hypertension, cardiac structure, and function has received little attention before. PATIENTS AND METHODS A total of 21 patients with severe spinal deformity were included in our study; all patients were examined by echocardiography and pulmonary function test before and after treatment. The correlations between PAP and pulmonary function were examined using Pearson correlation analysis. RESULTS The PAP decreased from 58.67 ± 20.24 to 39.00 ± 12.51 mm Hg, and the PAP of 42.86% of the patients returned to normal after treatment. Right cardiac enlargement, left ventricular diastolic function, and pulmonary function were improved at the same time. The ratio of left ventricular to right ventricular diameter returned to normal. Moderate correlations (correlation coefficient: -0.513 to -0.559) between PAP and forced vital capacity and forced expiratory volume in the first second were identified. CONCLUSIONS Pulmonary arterial hypertension, ventricular diastolic function, and pulmonary function were improved after halo-pelvic traction and thoracoplasty. A moderate negative correlation was identified between PAP and pulmonary function: the more pulmonary function improved, the more PAP decreased.
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Affiliation(s)
| | | | | | | | - Yijian Liang
- Department of Orthopedics, The Third People's Hospital of Chengdu, Chengdu, China
| | - Bin Yu
- Department of Orthopedics, The Third People's Hospital of Chengdu, Chengdu, China
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Hua W, Li S, Feng X, Wang K, Yin H, Wu X, Zhang Y, Gao Y, Ling L, Yang C. Sequential correction of severe and rigid kyphoscoliosis: a new technical note and preliminary results. BMC Musculoskelet Disord 2023; 24:697. [PMID: 37653384 PMCID: PMC10469414 DOI: 10.1186/s12891-023-06736-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 07/19/2023] [Indexed: 09/02/2023] Open
Abstract
OBJECTIVE The present study is to evaluate the clinical outcomes of the sequential correction of severe and rigid kyphoscoliosis. METHODS Between January 2014 and December 2020, 27 adults with severe and rigid kyphoscoliosis underwent sequential correction combined with posterior grade 4 or grade 5 spinal osteotomy. Radiological parameters, including the major curve Cobb angle, kyphotic angle, coronal imbalance, and sagittal vertical axis (SVA), were compared. Patient self-reported health-related quality of life (HRQOL) scores were used to evaluate clinical outcomes. RESULTS The mean major curve Cobb angle improved from 134.30 ± 13.24° to 44.48 ± 9.34° immediately after surgery and to 46.11 ± 8.94° at the final follow-up. The mean kyphotic angle improved from 112.15 ± 20.28° to 38.63 ± 15.00° immediately after surgery and to 39.85 ± 14.92° at the final follow-up. The mean preoperative major curve Cobb angle of grade 5 spinal osteotomy group was higher than that of grade 4 spinal osteotomy group. Coronal imbalance and SVA slightly improved. The patient self-reported HRQOL scores improved postoperatively and at the final follow-up. Activity, appearance and total scores of the SRS-22 of the grade 5 spinal osteotomy group at the final follow-up were significantly better than those of the grade 4 spinal osteotomy group. CONCLUSIONS Sequential correction combined with posterior grade 4 or grade 5 spinal osteotomies is an excellent and safe treatment for severe and rigid kyphoscoliosis in adults. Sequential correction combined with posterior grade 5 spinal osteotomies can be used to correct severe and rigid kyphoscoliosis with higher major curve Cobb angle.
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Affiliation(s)
- Wenbin Hua
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Shuai Li
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xiaobo Feng
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Kun Wang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Huipeng Yin
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xinghuo Wu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yukun Zhang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yong Gao
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Li Ling
- Department of VIP Clinic, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Cao Yang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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9
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Grabala P, Chamberlin K, Grabala M, Galgano MA, Helenius IJ. No Benefits in Using Magnetically Controlled Growing Rod as Temporary Internal Distraction Device in Staged Surgical Procedure for Management of Severe and Neglected Scoliosis in Adolescents. J Clin Med 2023; 12:5352. [PMID: 37629394 PMCID: PMC10455145 DOI: 10.3390/jcm12165352] [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: 07/13/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Severe spinal curvatures (SSCs) in children and adolescents have long been treated with preoperative Halo traction, in its various variations. There are also several radical techniques available for the management of neglected SSCs, such as osteotomies; however, these can be risky. Comparing the treatment outcomes when using preoperative Halo Gravity Traction (HGT) against the use of a Magnetically Controlled Growing Rod (MCGR) as a temporary internal distraction (TID) device, we evaluated the differences in surgical and radiological outcomes. METHODS We conducted a retrospective study of 30 patients with SSCs, treated with HGT followed by posterior spinal fusion (PSF; Group 1, n = 18) or treated using a temporary MCGR as a TID followed by PSF (Group 2, n = 12). All patients underwent surgical treatment between 2016 and 2022. The inclusion criteria were SSC > 90°, flexibility < 30%, and the use of preoperative HGT followed by PSF or the two-stage surgical procedure with initial TID rod placement (Stage 1) followed by PSF (Stage 2). The evaluated parameters were as follows: rib hump, trunk height, and radiographic outcomes. All parameters were collected preoperatively, after the initial surgery, after final correction and fusion, and during the final follow-up. RESULTS In Group 1, we evaluated 18 patients with a mean age of 15.5 years; in Group 2, we evaluated 12 patients with a mean age of 14.2 years. The interval between the staged procedures averaged 32.7 days. The mean preoperative main curves (MC) were 118° and 112° in Group 1 and Group 2, respectively. After definitive surgery, the MC was corrected to 42° and 44° in G1 and G2, respectively. The mean percentage correction of the MC was similar in both groups (65% vs. 61% in G1 and G2, respectively). The mean preoperative thoracic kyphosis was 92.5° in G1 and 98° in G2, corrected to 43.8° in G1 and 38.8° in G2. Trunk height increased by 9 cm on average. CONCLUSIONS There are no benefits in using a MCGR as a temporary internal distraction device in the management of neglected scoliosis in adolescents. Surgical treatment of severe scoliosis may be safe, with a reduced risk of potential complications, when using preoperative HGT. A specific intraoperative complication when using a MCGR as a temporary internal distraction device was a 50% risk of transient neuromonitoring changes, due to significant force applied to the spine and radical distraction of the spine. We achieved similar clinical, radiographic, and pulmonary function outcomes for both techniques. The use of HGT causes less blood loss with a shorter overall time under anesthesia. Partial correction significantly aids the subsequent operation by facilitating a gradual reduction in the curvature, thereby reducing the difficulty of surgical treatment and the risk of neurological deficits.
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Affiliation(s)
- Pawel Grabala
- Department of Pediatric Orthopedic Surgery and Traumatology, University Children’s Hospital, Waszyngtona 17, 15-274 Bialystok, Poland
- Paley European Institute, Al. Rzeczypospolitej 1, 02-972 Warsaw, Poland
| | - Kelly Chamberlin
- Department of Neurosurgery, University of North Carolina, Chapel Hill, NC 27516, USA; (K.C.); (M.A.G.)
| | - Michal Grabala
- 2nd Clinical Department of General and Gastroenterogical Surgery, Medical University of Bialystok, ul. M. Skłodowskiej-Curie 24a, 15-276 Bialystok, Poland;
| | - Michael A. Galgano
- Department of Neurosurgery, University of North Carolina, Chapel Hill, NC 27516, USA; (K.C.); (M.A.G.)
| | - Ilkka J. Helenius
- Department of Orthopedics and Traumatology, Helsinki University Hospital, 00260 Helsinki, Finland;
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Braun S, Brenneis M, Schönnagel L, Caffard T, Diaremes P. Surgical Treatment of Spinal Deformities in Pediatric Orthopedic Patients. Life (Basel) 2023; 13:1341. [PMID: 37374124 DOI: 10.3390/life13061341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/04/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
Scoliosis and Scheuermann's disease are common spinal deformities that affect a substantial population, particularly adolescents, often impacting their quality of life. This comprehensive review aims to present a detailed understanding of these conditions, their diagnosis, and various treatment strategies. Through an extensive exploration of current literature, the review discusses the etiology of these spinal deformities and the use of diagnostic tools such as X-rays and MRI. It further delves into the range of treatment options available, from conservative approaches such as physiotherapy and bracing to more invasive surgical interventions. The review underscores the necessity of an individualized treatment approach, taking into account factors such as the patient's age, the severity of the curvature, and overall health. This all-encompassing perspective on scoliosis and Scheuermann's disease will aid in evidence-based decision making in their management with the goal of improving patient outcomes.
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Affiliation(s)
- Sebastian Braun
- Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany
- Stavros Niarchos Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY 10021, USA
| | - Marco Brenneis
- Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany
- Stavros Niarchos Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY 10021, USA
| | - Lukas Schönnagel
- Charité-Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, 10117 Berlin, Germany
- Spine Care Institute, Hospital for Special Surgery, New York, NY 10021, USA
| | - Thomas Caffard
- Spine Care Institute, Hospital for Special Surgery, New York, NY 10021, USA
- Department of Orthopaedic Surgery, University of Ulm, 89075 Ulm, Germany
| | - Panagiotis Diaremes
- Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany
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11
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La Maida GA, Della Valle A, Gallazzi E, Ferraro M, Cecconi D, Cicatelli A, Priano D, La Verde L, Misaggi B. Paraparesis and congenital severe hyperkyphosis in Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome: A rare deformity management during the Sars-Cov-2 pandemic. BRAIN & SPINE 2023; 3:101753. [PMID: 37197562 PMCID: PMC10154059 DOI: 10.1016/j.bas.2023.101753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 04/07/2023] [Accepted: 05/02/2023] [Indexed: 05/19/2023]
Abstract
Introduction Mayer-Rokitansky-Küster-Hauser syndrome (MRKH) syndrome can be classified into two types: type I (isolated) without extragenital abnormalities; type II (associated) with the presence of extragenital dimorphisms. Skeletal abnormalities are the second most frequent extragenital manifestations. Research question Association between MRKH and congenital scoliosis has been described; on the contrary, hyperkyphosis is very rare and sparsely described in the medical literature. Here we report our experience in the management of thoracolumbar hyperkyphosis in 16-year-old patient diagnosed with MRKH syndrome with an acute neurological impairment due to T11-T12 disc herniation. Material and methods Clinical and radiological images of the case were retrieved from the medical notes, operative records and imaging system. Results Posterior surgical correction was proposed to treat the severe spinal deformity; however, surgery was delayed because of SARS-CoV2 pandemic outbreak. During the pandemic, the patient had a major clinical and radiological deterioration with development of paraparesis. Complete clinical resolution of the paraparesis and restoration of balance was achieved with a two stage surgical approach, with a first anterior stage followed by a delayed posterior approach aimed at deformity correction. Discussion Congenital kyphosis are rare deformities that can progress rapidly leading to severe neurological deficits and worsening of the deformity. When patient has neurological deficit the surgical strategy to address the neurological problem first and plan the more complex and demanding corrective surgery remains a valid strategy that must be consider. Conclusion This is the first reported case of hyperkyphosis in Mayer-Rokitansky-Küster-Hauser syndrome (MRKH) syndrome surgically treated.
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Affiliation(s)
- Giovanni Andrea La Maida
- U.O. Ortopedia e Traumatologia per le Patologie Della Colonna Vertebrale, ASST G. Pini - CTO, Milano, Italy
| | - Andrea Della Valle
- U.O. Ortopedia e Traumatologia per le Patologie Della Colonna Vertebrale, ASST G. Pini - CTO, Milano, Italy
| | - Enrico Gallazzi
- U.O. Ortopedia e Traumatologia per le Patologie Della Colonna Vertebrale, ASST G. Pini - CTO, Milano, Italy
| | - Marcello Ferraro
- U.O. Ortopedia e Traumatologia per le Patologie Della Colonna Vertebrale, ASST G. Pini - CTO, Milano, Italy
| | - Davide Cecconi
- U.O. Ortopedia e Traumatologia per le Patologie Della Colonna Vertebrale, ASST G. Pini - CTO, Milano, Italy
| | - Alfonso Cicatelli
- U.O. Ortopedia e Traumatologia per le Patologie Della Colonna Vertebrale, ASST G. Pini - CTO, Milano, Italy
| | - Daniele Priano
- U.O. Ortopedia e Traumatologia per le Patologie Della Colonna Vertebrale, ASST G. Pini - CTO, Milano, Italy
| | - Luca La Verde
- Dipartimento di Scienze Biomediche per La Salute, Università Degli Studi di Milano, Milano, Italy
| | - Bernardo Misaggi
- U.O. Ortopedia e Traumatologia per le Patologie Della Colonna Vertebrale, ASST G. Pini - CTO, Milano, Italy
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12
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O'Donnell J, Garcia S, Ali S, Asturias A, Swarup I. Indications and Efficacy of Halo-Gravity Traction in Pediatric Spinal Deformity: A Critical Analysis Review. JBJS Rev 2023; 11:01874474-202303000-00001. [PMID: 36881664 DOI: 10.2106/jbjs.rvw.22.00204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
» Halo-gravity traction (HGT) is a well-established technique for correcting severe spinal deformity in pediatric patients. » HGT induces soft-tissue relaxation and gradually lengthens the spine, and it can be used preoperatively and intraoperatively. » It is typically indicated for spinal deformity over 90° in any plane and medical optimization. » There are several complications associated with the use of HGT, and it is critical to follow a protocol and perform serial examinations to minimize this risk.
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Affiliation(s)
- Jennifer O'Donnell
- Division of Pediatric Orthopaedic Surgery, UCSF Benioff Children's Hospital, University of California San Francisco, Oakland, California
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13
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Frank S, Piantoni L, Tello CA, Remondino RG, Galaretto E, Falconi BA, Pereyra LN, Noël MA. Evaluation of outpatient halo-gravity traction in patients with severe scoliosis: development of a monitoring device. Spine Deform 2023; 11:351-357. [PMID: 36436117 DOI: 10.1007/s43390-022-00623-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 11/19/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Patients with severe spinal deformities represent a major clinical and surgical challenge. Halo-gravity traction (HGT) is a traditional method to correct the deformity prior to surgery. Typically, children undergoing HGT remain in the hospital until surgery. Therefore, it has been suggested to treat these children at lower level healthcare centers or even at home. The aim of this study was to develop a tool to assess patient adherence to HGT together with a program to analyze traction results. MATERIALS AND METHODS An original recording system was designed with an Arduino Nano®. The data extracted from the memory card were compiled into a text file and then analyzed with the MatLab R2018a MathWorks®. RESULTS Five patients receiving HGT for severe scoliosis were asked to use the device both in the wheelchair and in bed to evaluate its usefulness. CONCLUSIONS A device was developed to monitor the use of HGT at home. The device provides information on the time of HGT use and the traction weight placed throughout the day, as well as on the correct functioning of the system in bed and in the wheelchair.
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Affiliation(s)
- Sofía Frank
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881. C1245AAM. CABA, Buenos Aires, Argentina.
| | - Lucas Piantoni
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881. C1245AAM. CABA, Buenos Aires, Argentina
| | - Carlos A Tello
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881. C1245AAM. CABA, Buenos Aires, Argentina
| | - Rodrigo G Remondino
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881. C1245AAM. CABA, Buenos Aires, Argentina
| | - Eduardo Galaretto
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881. C1245AAM. CABA, Buenos Aires, Argentina
| | - Boris A Falconi
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881. C1245AAM. CABA, Buenos Aires, Argentina
| | - Leandro N Pereyra
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881. C1245AAM. CABA, Buenos Aires, Argentina
| | - Mariano A Noël
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881. C1245AAM. CABA, Buenos Aires, Argentina
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14
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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.
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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
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