Skip to main content
SpringerLink
Log in

Posterior-only surgery with preoperative skeletal traction for management of severe scoliosis

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Purpose

The surgical treatment of severe adolescent spinal deformities is challenging and carries substantial risks of mortality and morbidity. To mitigate this risk, surgeons have employed various methods as this study designed to evaluate the safety and effectiveness of preoperative halo-femoral or halo gravity traction (HGT) followed by posterior-only surgery in the management of severe scoliosis.

Method

A total number of 23 patients with severe scoliosis treated by preoperative skeletal traction (halo gravity or halo femoral) followed by posterior fusion and instrumentation in one stage. All patients were followed for a minimum of 2 years after surgery.

Results

The average age of the patients was 12.7 years at the time of surgery. Mean of the Cobb angle improved from 99.9° ± 8.2° preoperatively to 75.3° ± 8° post-traction and 49.5° ± 7.7° postoperatively. Kyphosis angle corrected from 56.4° ± 9.5° to 38.6° ± 5.8°. The preop-FVC% was 41 ± 6.1% and after 1 year follow-up FVC% was 45.7 ± 7.7%. No patients required an anterior release due to amount of their deformity.

Discussion

Despite the benefits of modern instrumentation procedures, the treatment of severe scoliosis can be very competing. We think that by applying preoperative halo femoral traction and halo-gravity traction, managing severe scoliosis will be in safe and easy manner and can lead to better deformity correction and less neurological complications and facilitate to avoid anterior operation for severe scoliosis and its related complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Buchowski JM, Bhatnagar R, Skaggs DL et al (2006) Temporary internal distraction as an aid to correction of severe scoliosis. J Bone Joint Surg Am 88:2035–2041

    PubMed  Google Scholar 

  2. Ruf M, Letko L, Matis N, et al (2013) Effect of anterior mobilization and shortening in the correction of rigid idiopathic thoracic scoliosis. Spine (Phila Pa 1976) 38: E1662–E1668

    Article  Google Scholar 

  3. Takeshita K, Lenke LG, Bridwell KH, et al (2006) Analysis of patients with nonambulatory neuromuscular scoliosis surgically treated to the pelvis with intraoperative halo-femoral traction. Spine (Phila Pa 1976) 31: 2381–2385

    Article  Google Scholar 

  4. Bogunovic L, Lenke LG, Bridwell KH et al (2013) Preoperative halogravity traction for severe pediatric spinal deformity: complications, radiographic correction, and changes in pulmonary function. Spine Deform 1:33–39

    Article  PubMed  Google Scholar 

  5. Garabekyan T, Hosseinzadeh P, Iwinski HJ et al (2014) The results of preoperative halo-gravity traction in children with severe spinal deformity. J Pediatr Orthop B 23:1–5

    Article  PubMed  Google Scholar 

  6. Park DK, Braaksma B, Hammerberg KW et al (2013) The effi cacy of preoperative halo-gravity traction in pediatric spinal deformity the effect of traction duration. J Spinal Disord Tech 26:146–154

    Article  PubMed  Google Scholar 

  7. Rinella A, Lenke L, Whitaker C, et al (2005) Perioperative halo-gravity traction in the treatment of severe scoliosis and kyphosis. Spine (Phila Pa 1976) 30:475–482

    Article  Google Scholar 

  8. Nemani VM, Kim HJ, Bjerke-Kroll BT (2015) Preoperative halo-gravity traction for severe spinal deformities at an SRS-GOP site in West Africa: protocols, complications, and results. Spine (Phila Pa 1976) 40(3):153–161

    Article  Google Scholar 

  9. Pehrsson K, Danielsson A, Nachemson A (2001) Pulmonary function in adolescent idiopathic scoliosis: a 25 year follow-up after surgery or start of brace treatment. Thorax 56:388–393

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Burrows B, Cline MG, Knudson RJ, Taussig LM, Lebowitz MD (1983) A descriptive analysis of the growth and decline of the FVC and FEV1. Chest 83:717–724

    Article  CAS  PubMed  Google Scholar 

  11. Pehrsson K, Larsson S, Oden A, Nachemson A (1992) Long-term follow-up of patients with untreated scoliosis. A study of mortality, causes of death, and symptoms. Spine 17:1091–1096

    Article  CAS  PubMed  Google Scholar 

  12. Qiu Y, Zhu LH, Lv JY et al (2001) Surgical strategy and correction technique for scoliosis of more than 90°. Chin J Surg 39:102–105

    Google Scholar 

  13. Li M, Liu Y, Zhu XD et al (2004) Surgical results of one stage anterior release and posterior correction for treatment of severe scoliosis. Chin J Orthop (Chin) 24:271–275

    Google Scholar 

  14. Newton PO, Wenger DR, Mubarak SJ et al (1997) Anterior release and fusion in pediatric spinal deformity. A comparison of early outcome and cost of thoracoscopic and open thoracotomy approaches. Spine 22:1398–1406

    Article  CAS  PubMed  Google Scholar 

  15. King A, Mills T, Loe WA Jr et al (2000) Video-assisted thoracoscopic surgery in the prone position. Spine 25:2403–2406

    Article  CAS  PubMed  Google Scholar 

  16. Niemeyer T, Freeman F, Grevitt et al (2000) Anterior thoracoscopic surgery followed by posterior instrumentation and fusion in spinal deformity. Eur Spine J 9:499–504

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Murray RJ (2007) Respiratory manifestations of extrapulmonary disorders. Elsevier Saunders, Philadelphia

    Google Scholar 

  18. Hempfing A, Koller H, Ferraris L, Meier O (2008) The effect of concave rib osteotomies on spinal flexibility in AIS: a biomechanical intra-operative assessment of spinal rigidity using a strain gauge distraction device. In: IMAST 2008, Hong Kong, China

  19. Rawlins BA, Winter RB, Lonstein JE, Denis FM, Kubic PT, Wheeler WB, Ozolins AL (1996) Reconstructive spine surgery in pediatric patients with major loss in vital capacity. J Pediatr Orthop 16:284–292

    Article  CAS  PubMed  Google Scholar 

  20. Kim YJ, Lenke LG, Bridwell KH et al (2005) Pulmonary function in adolescent idiopathic scoliosis relative to the surgical procedure. J Bone Joint Surg Am 87:1534–1541

    PubMed  Google Scholar 

  21. Lenke LG, Newton PO, Marks MC et al (2004) Prospective pulmonary function comparison of open versus endoscopic anterior fusion combined with posterior fusion in adolescent idiopathic scoliosis. Spine 29:2055–2060

    Article  PubMed  Google Scholar 

  22. Vendantam R, Lenke LG, Bridwell KH et al (2000) A prospective evaluation of pulmonary function in patients with adolescent idiopathic scoliosis relative to the surgical approach used for spinal arthrodesis. Spine 25:82–90

    Article  Google Scholar 

  23. Dobbs MB, Lenke LG, Kim YJ et al (2006) Anterior/posterior spinal instrumentation versus posterior instrumentation alone for the treatment of adolescent idiopathic scoliotic curves more than 90°. Spine 31:2386–2391

    Article  PubMed  Google Scholar 

  24. Suk SI, Lee CK, Kim WJ et al (1995) Segmental pedicle screw fixation in the treatment of thoracic idiopathic scoliosis. Spine 20:1399–1405

    Article  CAS  PubMed  Google Scholar 

  25. Liljenqvist U, Lepsien U, Hackenberg L et al (2002) Comparative analysis of pedicle screw and hook instrumentation in posterior correction and fusion of idiopathic thoracic scoliosis. Eur Spine J 11:336–343

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Burton DC, Andrew AS, Marc AA et al (2005) The treatment of large (>70°) thoracic idiopathic scoliosis curves with posterior instrumentation and arthrodesis: when is anterior release indicated. Spine 17:1979–1984

    Article  Google Scholar 

  27. Zhang HQ, Lu SJ, Chen J et al (2007) Treatment of severe idiopathic scoliosis with wide posterior spinal release and 3D spinal correction. Chin J Spine Spinal Cord 17:274–279

    Google Scholar 

  28. Lenke LG, Betz RR, Harms J et al (2001) Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis. J Bone Joint Surg(Am) 83:1169–1181

    Article  Google Scholar 

  29. Dewald RL, Ray RD (1970) Skeletal traction for the treatment of severe scoliosis. The University of Illinois halo-hoop apparatus. J Bone Joint Surg (Am) 52:233–238

    Article  CAS  Google Scholar 

  30. Edgar MA, Chapman RH, Glasgow MM (1982) Pre-operative correction in adolescent idiopathic scoliosis. J Bone Joint Surg (Br) 64:530–535

    CAS  Google Scholar 

  31. Ginsburg GM, Bassett GS (1998) Hypoglossal nerve injury caused by halosuspension traction. A case report. Spine 23:1490–1493

    Article  CAS  PubMed  Google Scholar 

  32. Kalamchi A, Yau AC, O’Brien JP, et al (1976) Halo-pelvic distraction apparatus. An analysis of one hundred and fifty consecutive patients. J Bone Joint Surg (Am) 58:1119–1125

    Article  CAS  Google Scholar 

  33. Letts RM, Palakar G, Bobecko WP (1975) Preoperative skeletal traction in scoliosis. J Bone Joint Surg (Am) 57:616–619

    Article  CAS  Google Scholar 

  34. O’Brien JP, Yau AC, Hodgson AR (1973) Halo pelvic traction: a technique for severe spinal deformities. Clin Orthop 93:179–190

    Article  Google Scholar 

  35. O’Brien JP, Yau AC, Smith TK et al (1971) Halo pelvic traction. A preliminary report on a method of external skeletal fixation for correcting deformities and maintaining fixation of the spine. J Bone Joint Surg (Br) 53:217–229

    Google Scholar 

  36. Ransford AO, Manning CW (1975) Complications of halo-pelvic distraction for scoliosis. J Bone Joint Surg (Br) 57:131–137

    Article  CAS  Google Scholar 

  37. Sink EL, Karol LA, Sanders J et al (2001) Efficacy of perioperative halo-gravity traction in the treatment of severe scoliosis in children. J Pediatr Orthop 21:519–524

    CAS  PubMed  Google Scholar 

  38. Cotel Y (1973) A new technique of correction and fusion. Isr J Med Sci 9:759–766

    Google Scholar 

  39. Cotel Y (1975) Traction in the treatment of vertebral deformity. J Bone Joint Surg (Br) 57:260

    Google Scholar 

  40. Perry J, Nickel V (1959) Total-cervical spine fusion for neck paralysis. J Bone Joint Surg (Am) 41:37–60

    Article  Google Scholar 

  41. Mehlman CT, Al-Sayyad MJ, Crawford AH (2004) Effectiveness of spinal release and halo-femoral traction in the management of severe spinal deformity. J Pediatr Orthop 24:667–673

    Article  PubMed  Google Scholar 

  42. Wilkins C, MacEwen GD (1977) Cranial nerve injury from halo traction. Clin Orthop 126:106–110

    Google Scholar 

  43. White A, Panjabi M (1990) Clinical Biomechanics of the Spine. JB Lippincott, Philadelphia

    Google Scholar 

  44. Wazeka AN, DiMaio MF, Boachie-Adjei O (2004) Outcome of pediatric patients with severe restrictive lung disease following reconstructive spine surgery. Spine 29:528–533

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. School of Medicine, Shariati Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran

    Saeedreza Mehrpour & Reza Rezaei

  2. School of Medicine, Students’ Scientific Research Center (SSRC), Exceptional Talent Development Center (ETDC), Tehran University of Medical Sciences (TUMS), Tehran, Iran

    Reza Sorbi

  3. Department of Pediatric Orthopaedics, Robert Debré Hospital, Paris Diderot University, Paris, France

    Keyvan Mazda

Authors
  1. Saeedreza Mehrpour
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Reza Sorbi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Reza Rezaei
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Keyvan Mazda
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Reza Sorbi.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest. There was no funding source for this study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mehrpour, S., Sorbi, R., Rezaei, R. et al. Posterior-only surgery with preoperative skeletal traction for management of severe scoliosis. Arch Orthop Trauma Surg 137, 457–463 (2017). https://doi.org/10.1007/s00402-017-2642-x

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-017-2642-x

Keywords

Search

Navigation