The valuation of concave-side thoracoplasty on the treatment of extremely severe scoliosis with severe pulmonary dysfunction on the base of halo-pelvic traction

Effectiveness of Halo-Pelvic Traction and Thoracoplasty for Pulmonary Artery Pressure and Cardiopulmonary Function in Patients With Severe Spinal Deformity

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.

BEZOLD JARISCH REFLEX DURING HALO-GRAVITY TRACTION: CASE REPORT

ABSTRACT Halo-gravity traction is an option that can be used in the treatment of severe spinal deformities. The author reports a complication not yet described in the literature in which rapid correction of the deformity triggered the Bezold Jarisch reflex. Level of evidence IV; Case Series.

Analysis of the corrective contribution of strong halo-femoral traction in the treatment of severe rigid nonidiopathic scoliosis

Introduction

Strong halo-femoral traction has been widely used in the field of severe rigid scoliosis correction. The objective of this study was to analyze the corrective contribution of strong halo-femoral traction in the treatment of severe rigid nonidiopathic scoliosis and discuss its meaning.

Material and methods

A retrospective review was performed for patients with severe rigid nonidiopathic scoliosis who were treated with halo-femoral traction in our center from December 2008 to December 2015. All cases underwent halo-femoral traction for 2 to 4 weeks before a one-stage posterior operation, and the absolute and relative contribution rates of each orthopedic factor (bending, fulcrum, traction, surgery) were analyzed.

Results

A total of 38 patients were included (15 males and 23 females), with a mean age of 16.4 ± 3.73 years (10–22 years) and follow-up of 55.05 ± 6.63 months (range 40–68 months). The etiology was congenital in 17 patients, neuromuscular in 14 patients, neurofibromatosis-1 in 3 patients, and Marfan syndrome in 2 patients. Congenital high scapular disease with scoliosis was found in 2 patients. The mean coronal Cobb angle of the major curve was 97.99° ± 11.47° (range 78°–124°), with a mean flexibility of 15.68% ± 6.65%. The absolute contribution rate (ACR) of bending was 27.26% ± 10.16%, the ACR of the fulcrum was 10.91% ± 2.50%, the ACR of traction was 32.32% ± 11.41%, and the ACR of surgery was 29.50% ± 9.70%. A significant difference in correction was noted between the ACRs of traction and the fulcrum (P < 0.05).

Discussion

Strong halo-femoral traction plays a relatively significant role in the treatment of severe rigid nonidiopathic scoliosis while decreasing the risk of operation, and it is a safe and effective method for the treatment of severe rigid nonidiopathic scoliosis.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13018-020-02093-8.