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Liu Z, Zhong J, Ma S, Yang C, Wan W, Wan Z, Mamat M, Wang Y, Ge Z, Cao K. Improvement of Pulmonary Function and Reconstructed 3-Dimensional Lung Volume After Halo-Pelvic Traction Combined With Posterior Correction for Severe Rigid Spinal Scoliosis: A Multicenter Study. Neurosurgery 2023:00006123-990000000-00972. [PMID: 37991353 DOI: 10.1227/neu.0000000000002779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 10/10/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Severe rigid spinal scoliosis (SRSS) leads to severe restrictive ventilation dysfunction. Currently, the reports about the influence of preoperative halo-pelvic traction (HPT) combined with correction surgery on pulmonary function in patients with SRSS were relatively few. This study aims to investigate (1) the influence of preoperative HPT on lung volume and pulmonary function, (2) the further influence of the following correction surgery on lung volume and pulmonary function, and (3) the relationship among deformity correction, pulmonary function test outcomes, and computed tomography-based lung volume. METHODS A total of 135 patients with SRSS who underwent preoperative HPT and followed low-grade osteotomy correction surgery were reviewed. Spinal parameters, including proximal thoracic curve, main thoracic curve (MTC), lumbar curve, coronal balance, thoracic kyphosis, lumbar lordosis, sagittal vertical axis, pulmonary function test outcomes (forced vital capacity [FVC], the percentage of predicted forced vital capacity [FVC%], forced expiratory volume in 1 second [FEV1], total lung capacity [TLC]), and lung volume (Vin), were analyzed before, after HPT and at the final follow-up, respectively. RESULTS The mean FVC, FVC%, FEV1, and TLC increased from 1.67 L, 51.13%, 1.47 L, and 2.37 L to 1.95 L, 64.35%, 1.75 L, and 2.78 L, respectively, after HPT and further improved to 2.22 L, 72.14%, 1.95 L, and 3.15 L, respectively, at the final follow-up. The mean Vin increased from 1.98 L to 2.42 L after traction and further increased to 2.76 L at the final follow-up. The variation of MTC was correlated with the improvement of FVC (r = 0.429, P = .026), FVC% (r = 0.401, P = .038), FEV1 (r = 0.340, P = .043), and TLC (r = 0.421, P = .029) and the variation of Vin (r = 0.425, P = .015) before HPT and after surgery. CONCLUSION Preoperative HPT can improve preoperative pulmonary function and enhance the preoperative lung volume. There were significant correlations among the variations of MTC, pulmonary function indexes, and lung volume before HPT and after surgery in patients with SRSS.
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Affiliation(s)
- Zhiming Liu
- The Orthopedic Hospital, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Junlong Zhong
- The Orthopedic Hospital, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Shengbiao Ma
- The Orthopedic Hospital, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Cao Yang
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenbing Wan
- Department of Orthopedics, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zongmiao Wan
- The Orthopedic Hospital, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Mardan Mamat
- Department of Orthopedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yingsong Wang
- Department of Orthopedics, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zhaohui Ge
- Department of Orthopedics, General Hospital of Ningxia Medical University, Ningxia, China
| | - Kai Cao
- The Orthopedic Hospital, The First Affiliated Hospital of Nanchang University, Nanchang, China
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Huang X, Xiu P, Shu Y, Song Y, Zhou Z, Zhou C, Feng G, Wang L, Liu L, Tang J, Yang X. The Effect of Halo-Pelvic Traction on Bone Mineral Density of Vertebrae and Corresponding Risk Factors. Orthop Surg 2023; 15:2918-2926. [PMID: 37706221 PMCID: PMC10622268 DOI: 10.1111/os.13858] [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: 04/15/2023] [Revised: 07/19/2023] [Accepted: 07/24/2023] [Indexed: 09/15/2023] Open
Abstract
OBJECTIVES Decreased bone mineral density (BMD) is associated with complications in implantation surgery for severe spinal deformity. In this quantitative study, we aimed to investigate the impact of halo-pelvic traction on vertebral bone mineral density (BMD) and identify the risk factors for a decrease in BMD. METHODS Patients who underwent halo-pelvic traction at our hospital between 2019 and 2022 were included in the study. Patients' data, including height, weight, and BMD pre- and post-traction, were collected and analyzed. Quantitative computed tomography (QCT) was used to determine the BMD. The paired rank sum test was used to evaluate the changes in each measurement parameter. Linear regression was used to identify risk factors for a decrease in BMD. RESULTS Fifteen patients were included in the study, nine women and six men, with an average age of 21.2 ± 7.3 years. Eleven patients had severe rigid scoliosis, while four had tuberculotic kyphosis. One expert measured the BMD values of 345 vertebrae using QCT. The average traction time was 143.3 ± 44.4 days. The average pre-traction BMD was 183.1 ± 73.8 mg/cm3 , and the average post-traction BMD was 140.5 ± 61.3 mg/cm3 (p < 0.01) Patients' height increased from an average of 151.3 ± 12.8 cm pre-traction to 165.5 ± 13.7 cm post-traction (p < 0.01), with traction length averaging 14.3 ± 6.2 cm (p < 0.01). The Cobb angle of the main curve declined from an average of 112.5° ± 24.4° pre-traction to 67.7° ± 19.8° post-traction (p < 0.01). Linear regression revealed a positive correlation between BMD loss and traction length and a negative correlation between BMD loss and correction rate. CONCLUSIONS Halo-pelvic traction can lead to a decrease in the BMD of the spinal vertebrae, with traction length positively correlated with BMD loss and correction rate negatively correlated with BMD loss. To prevent osteoporosis, physicians should ensure a limited traction length while utilizing better management techniques.
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Affiliation(s)
- Xianming Huang
- Department of Orthopaedic Surgery, West China HospitalSichuan UniversityChengduChina
- Department of OrthopaedicsXinqiao Hospital of Army Medical UniversityChongqingChina
- Department of Pediatric SurgeryDazhou Central HospitalDazhouChina
| | - Peng Xiu
- Department of Orthopaedic Surgery, West China HospitalSichuan UniversityChengduChina
| | - Yi Shu
- Department of Radiology, West China HospitalSichuan UniversityChengduChina
| | - Yueming Song
- Department of Orthopaedic Surgery, West China HospitalSichuan UniversityChengduChina
| | - Zhongjie Zhou
- Department of Orthopaedic Surgery, West China HospitalSichuan UniversityChengduChina
| | - Chunguang Zhou
- Department of Orthopaedic Surgery, West China HospitalSichuan UniversityChengduChina
| | - Ganjun Feng
- Department of Orthopaedic Surgery, West China HospitalSichuan UniversityChengduChina
| | - Lei Wang
- Department of Orthopaedic Surgery, West China HospitalSichuan UniversityChengduChina
| | - Limin Liu
- Department of Orthopaedic Surgery, West China HospitalSichuan UniversityChengduChina
| | - Jing Tang
- Department of Radiology, West China HospitalSichuan UniversityChengduChina
| | - Xi Yang
- Department of Orthopaedic Surgery, West China HospitalSichuan UniversityChengduChina
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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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Liang H, Huo F, Sun L, Feng Y. An optimized "sTOP" strategy-based awake fiberoptic intubation for a patient with severe scoliosis after halo-pelvic traction. Clin Case Rep 2023; 11:e7599. [PMID: 37361661 PMCID: PMC10288068 DOI: 10.1002/ccr3.7599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/01/2023] [Accepted: 06/05/2023] [Indexed: 06/28/2023] Open
Abstract
Difficult Airway Society launched the new guideline for awake tracheal intubation (ATI) in adults with the goal of standardizing and promoting ATI techniques to protect the airway in 2020 (Anaesthesia, 2020;75:509). Specifically, the guideline highlighted that the key components of ATI are sedation, topicalization, oxygenation, and performance, coined "sTOP." To the best of our knowledge, anticipated difficult airway is the best indication for ATI. Patients with severe scoliosis undergoing halo-pelvic traction (HPT) are often with head and neck fixation, thereby contributing to the anticipated difficult airways. HPT was first used to fix unstable cervical vertebra segments in 1959, and gradually applied in the treatment of scoliosis (scoliosis or kyphosis Angle greater than 90 degrees is usually considered as severe scoliosis), with favorable efficacy and safety profile, and thus widely used in clinical practice (Clin Orthop Relat Res, 1973;93:179). To date, the improved HPT device usually consists of a head ring composed of 6 ~ 8 cranial nails, a pelvic ring composed of 6 ~ 8 iliac bone nails and 4 telescopic connecting rods, which can achieve all-day continuous traction. Usually, the average traction time was about 8 weeks (Chin Med J (Engt), 2012;125:1297). Our case described a planned awake fiberoptic intubation (AFOI) for a patient with severe scoliosis undergoing HPT via an optimized "sTOP" strategy.
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Affiliation(s)
- Hansheng Liang
- Department of AnesthesiologyPeking University People's HospitalBeijingChina
| | - Fei Huo
- Department of AnesthesiologyPeking University People's HospitalBeijingChina
| | - Liang Sun
- Department of AnesthesiologyPeking University People's HospitalBeijingChina
| | - Yi Feng
- Department of AnesthesiologyPeking University People's HospitalBeijingChina
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Machida M, Rocos B, Zeller R, Lebel DE. A comparison of three- and two-rod constructs in the correction of severe pediatric scoliosis. J Child Orthop 2023; 17:148-155. [PMID: 37034196 PMCID: PMC10080239 DOI: 10.1177/18632521231156438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 01/20/2023] [Indexed: 04/11/2023] Open
Abstract
Purpose Managing severe scoliosis is challenging and risky with a significant complication rate regardless of treatment strategy. In this retrospective comparative study, we report our results using a three-rod compared to two-rod construct in the surgical treatment of severe spine deformities to investigate which technique is safer, and which provides superior radiological outcomes. Methods Forty-six consecutive patients undergoing posterior spine fusion for scoliosis between 2006 and 2017 were identified in our institutional records. Inclusion criteria were minimum coronal deformity of 90°, age < 18 years at the time of surgery and a minimum 2 years of follow-up. Radiographic and clinical parameters, as well as post-operative complications were compared between the two groups. Results There were 21 patients in the three-rod group and 25 in the two-rod group. The mean preoperative major coronal deformity was 100°± 9 and 102°± 10 in the three-rod and two-rod, respectively (p = 0.6). The average major curve correction was 51% and 59% in three-rod and two-rod groups, respectively (p = 0.03). The post-operative thoracic kyphosis was 30°± 11 and 21°± 12 in the three-rod and the two-rod groups, respectively (p = 0.01). The surgical time was 476 ± 52 and 387 ± 84 min in three-rod and two-rod, respectively (p < 0.01). One patient in the two-rod cohort showed permanent post-operative sensory deficit. There were three unplanned returns to operating theater in the two-rod group. Conclusions Coronal correction was better with two-rod, whereas sagittal balance was superior with three-rod. Both techniques achieved balanced spine treating severe scoliosis. The two-rod technique was associated with a higher likelihood of requiring revision surgery. Level of evidence level 3.
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Affiliation(s)
- Masayoshi Machida
- Masayoshi Machida, Department of
Orthopaedic Surgery, The Hospital for Sick Children, 555 University Avenue,
Toronto, ON M5G 1X8, Canada.
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Sun Y, Zhang Y, Ma H, Tan M, Zhang Z. Halo-pelvic traction in the treatment of severe scoliosis: a 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 2023; 32:874-882. [PMID: 36622456 DOI: 10.1007/s00586-023-07525-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 11/07/2022] [Accepted: 01/02/2023] [Indexed: 01/10/2023]
Abstract
PURPOSE To provide better evidence of the efficacy and safety of preoperative halo-pelvic traction on the improvements of deformity and pulmonary functions in patients with severe scoliosis. METHODS Electronic database searches were conducted including the Cochrane Library, PubMed, Web of Science and Embase. All studies of halo-pelvic traction for the management of severe spinal deformity were included. We referred to a list of four criteria developed by the Agency for Healthcare Research and Quality (AHRQ) to assess the quality of included studies. The meta-analysis was performed using RevMan 5.4 software. RESULTS Based on the study selection criteria, a total of eight articles consisting of a total of 210 patients were included. Statistically significant differences were found in coronal Cobb angle (P < 0.001), sagittal Cobb angle (P < 0.001) and height (P < 0.001) between pre- and post-traction. Sensitivity analysis was conducted, and there were substantial changes in heterogeneity with preoperative thoracoplasty subgroup in coronal Cobb angle (P < 0.001). Three trials including 74 subjects reported FVC and FEV1 predicted value between pre- and post-traction. There were statistically significant differences in FVC, FVC%, FEV1 and FEV1% (P < 0.001). The complication rate was 6.6-26.7%, and symptoms disappeared after reasonable traction strategy and intensive care. CONCLUSIONS Preoperative halo-pelvic traction achieved significant improvements in spinal deformity and pulmonary functions, with minor and curable complications. Thus, it is an effective and safe solution before surgery and may be the optimal choice for severe scoliosis. In light of the heterogeneity and limitations, future researches are needed to better determine the long-term efficacy on comprehensive assessment and to explore the appropriate traction system.
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Affiliation(s)
- Yan Sun
- Department of Orthopaedics, Guang'an Men Hospital, China Academy of Chinese Medical Sciences, No.5 Beixiange St, Xicheng District, Beijing, 100053, People's Republic of China
| | - Yong Zhang
- Department of Orthopaedics, Guang'an Men Hospital, China Academy of Chinese Medical Sciences, No.5 Beixiange St, Xicheng District, Beijing, 100053, People's Republic of China
| | - Haoning Ma
- Department of Orthopaedics, China-Japan Friendship Hospital, Beijing, 100029, People's Republic of China
| | - Mingsheng Tan
- Department of Orthopaedics, China-Japan Friendship Hospital, Beijing, 100029, People's Republic of China.
| | - Zhihai Zhang
- Department of Orthopaedics, Guang'an Men Hospital, China Academy of Chinese Medical Sciences, No.5 Beixiange St, Xicheng District, Beijing, 100053, People's Republic of China.
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The Efficacy of a Posterior Approach to Surgical Correction for Neglected Idiopathic Scoliosis: A Comparative Analysis According to Health-Related Quality of Life, Pulmonary Function, Back Pain and Sexual Function. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020299. [PMID: 36832428 PMCID: PMC9955926 DOI: 10.3390/children10020299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 01/28/2023] [Accepted: 02/01/2023] [Indexed: 02/08/2023]
Abstract
BACKGROUND This study aimed to evaluate the treatment outcomes of severe idiopathic scoliosis (IS) and hypothesized that surgical treatment would have a superior impact on the health-related quality of life (HRQoL), pulmonary function (PF), back pain, and sexual function. METHODS We retrospectively reviewed 195 consecutive patients with IS classified into severe (SG) and moderate groups (MG) with a minimum follow-up of two years. RESULTS The mean preoperative curve was 131° and 60° in the SG and MG, respectively. The mean preoperative flexibility in the bending films averaged between 22% in the SG and 41% in the MG. After definitive surgery, the main curve was corrected to 61° and 18° in the SG and MG, respectively. The mean preoperative thoracic kyphosis was 83° in the SG and 25° in the MG, which was corrected to 35° in the SG and 25° in the MG. At baseline, the percentage of predicted lung volume (FVC) was significantly lower in the SG than that in the MG (51.2% vs. 83%). The baseline percentage of the predicted FEV1 values was also significantly lower in the SG than in the MG (60.8% vs. 77%). During the two-year follow-up, the percentage of predicted FVC showed significant improvement in the SG (69.9%) (p < 0.001), and the percentage of predicted FEV1 values during the follow-up improved significantly in the SG (76.9%) (p < 0.001) compared with the MG (81%), with no statistical difference observed during the two-year follow-up. The SRS-22r showed a clinically and statistically significant improvement in the preoperative results to those of the final follow-up (p < 0.001). CONCLUSIONS Surgical treatment of severe scoliosis can be safe. It provided a mean correction of the deformity for 59% of patients and significantly improved respiratory function, with the percentage of predicted forced expiratory volume in 1 s improving by 60% and the forced vital capacity improving by 50%, resulting in clinically and statistically significant improvements in the SRS-22r, HRQoL outcome scores, and back pain (reduced from 36% to 8%), as well as improved sexual function. The planned surgical treatment can achieve a very significant deformity correction with a minimal risk of complications. The surgical treatment has a superior impact on the quality of life patients with severe spinal deformities and significantly improves function in every sphere of life.
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Effects of combined adjustable Halo-pelvic fixation brace on cervical spine alignment in patients with severe rigid spinal deformity. BMC Surg 2022; 22:208. [PMID: 35643545 PMCID: PMC9148464 DOI: 10.1186/s12893-022-01662-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 05/18/2022] [Indexed: 11/25/2022] Open
Abstract
Objective To evaluate the effect of continuous traction with a combined adjustable Halo-pelvic fixation brace on the cervical spine alignment in patients with severe rigid spinal deformity and analyze its related factors. Methods We conducted a retrospective cohort study of 21 patients with severe rigid spinal deformity treated in our department between 2015 and 2019. All subjects received combined adjustable Halo-pelvic fixation brace traction before secondary orthopedic surgery. The influence of the Halo-pelvic fixation brace on the cervical spine alignment was evaluated by measuring the parameters of lateral cervical X-ray at three time points: before traction, at the end of traction, and 6 months after orthopedic surgery. The correlation between parameter changes and total traction duration was analyzed to explore factors influencing cervical alignment. Results The C2L-C7L angle was 22.40 ± 15.91° before traction, which decreased to 5.91 ± 6.78° at the end of traction but increased to 14.51 ± 10.07° after orthopedic surgery (BT vs ET p < 0.005, ET vs AOS p < 0.005, BT vs AOS p < 0.005). Accordingly, C2L-C7U angle, C2L-C6L angle, C2L-C6U angle, C2L-C5L angle, C7 or T1 slope, C2-C7 SVA, SCA, C2-T1 Ha, C0 slope, and C0-C2 angle also changed similarly to C2L-C7L angle. Furthermore, moderate correlation was observed between C2L-C7L angle and total traction volume (r = 0.563, p = 0.008) and SCA and traction duration (r = 0.525, p = 0.015). However, no significant correlation was found between other cervical alignment parameters and total traction volume and traction duration. Conclusions The continuous traction of a combined adjustable Halo-pelvic fixation brace can affect the cervical spine alignment of patients with severe rigid spinal deformity and straighten the physiological curvature of the cervical spine. However, the sagittal alignment gradually recovers after the traction, without any adverse effects on the orthopedic surgery and global balance after the operation; therefore, this apparatus is worthy of wide application.
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Preoperative Halo-Femoral Traction With Posterior Surgical Correction for the Treatment of Extremely Severe Rigid Congenital Scoliosis (Cobb Angle >120°). J Am Acad Orthop Surg 2022; 30:421-427. [PMID: 35213513 DOI: 10.5435/jaaos-d-21-01095] [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] [Received: 11/03/2021] [Accepted: 01/09/2022] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION To evaluate the effectiveness and safety of preoperative halo-femoral traction (HFT) with posterior surgical correction for the treatment of extremely severe rigid congenital scoliosis (>120°). METHODS We reviewed the records of all patients with extremely severe rigid congenital scoliosis (>120°) treated with preoperative HFT from 2010 through 2018. Radiographic measurements were performed. The period of traction, blood loss, operation time, complications, and pulmonary function test results were recorded. RESULTS A total of 11 patients were included in the study. All patients underwent preoperative HFT with posterior surgical correction. The mean preoperative main curve Cobb angle was 127.9° ± 4.4°, and the average correction rate was 33.5% posttraction, 54.8% postoperation, and 55.3% at the latest follow-up. Pulmonary function improved significantly after traction, and forced vital capacity and forced expiratory volume in 1 second increased from 34.7% and 33.4% to 48.1% and 48.5%, respectively. Only one patient experienced halo pin infection during HFT. No patients experienced permanent neurologic deficits or death. CONCLUSION For extremely severe rigid congenital scoliosis with a Cobb angle greater than 120°, preoperative HFT with posterior surgical correction offers an effective and safe corrective option. The perioperative complication rate can be partially reduced. STUDY DESIGN Retrospective study.
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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.
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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
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