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Halo-gravity traction followed by definitive fusion in severe early onset scoliosis: results of a trunk analysis based on biplanar 3D reconstructions

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Abstract

Purpose

Definitive fusion can be considered in early onset scoliosis (EOS) around triradiate cartilage closure. Halo-gravity traction (HGT) is an old strategy that can help lengthen and balance the spine before fusion. The postoperative changes of the trunk have never been investigated to date with modern imaging. The goal of this study was to analyze the 3D radiological outcomes, and the associated pulmonary function, of a cohort of severe EOS patients treated by definitive posterior fusion prepared by HGT.

Methods

All consecutive EOS patients with severe (> 85°) and stiff (flexibility < 25%) curves, treated by HGT followed by posterior fusion, were followed. 3D radiological measurements and pulmonary function were assessed.

Results

Forty-nine EOS patients underwent fusion, with a mean follow-up of 4 years (± 1). Age at surgery averaged 13.5 years old. HGT protocol reached on average 41% of body weight. Mean preoperative 3D Cobb angle was 95° (± 10) and final correction averaged 68.4% after surgery. 3D T4T12 kyphosis was reduced after surgery (11°, p < 0.01), while the apical vertebral rotation was improved by 27.8% (p = 0.06). 3D thoracic volume increased after surgery (p = 0.02), with a 3D T1T12 height gain averaging 3.7 cm (± 2). Both parameters were significantly correlated with total lung capacity improvement. Seven complications (14.2%) were reported, and 5 patients (10.6%) underwent unplanned revision.

Conclusion

HGT is a safe and efficient strategy to prepare posterior fusion in severe EOS patients. The 3D trunk analysis demonstrated significant postoperative gains in thoracic and spinal lengths, as well as in thoracic volume.

Level of evidence

IV.

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Funding

None of the authors received financial support for this study.

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Authors and Affiliations

  1. Department of Paediatric Orthopaedics, Robert Debré hospital, AP-HP, Paris University, 48 Boulevard Sérurier, 75019, Paris, France

    Anne-Laure Simon, Audrey Angelliaume, Adèle Happiette, Maxime Huneidi & Brice Ilharreborde

  2. Department of Paediatric Anaesthesiology, Robert Debré hospital, AP-HP, Paris University, Paris, France

    Florence Julien-Marsollier

Authors
  1. Anne-Laure Simon
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  2. Audrey Angelliaume
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  3. Adèle Happiette
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  4. Maxime Huneidi
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  5. Florence Julien-Marsollier
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  6. Brice Ilharreborde
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Contributions

BI contributed to conception and design; AH and MH contributed to administrative support; BI and FJM contributed to provision of study material and patients; AA contributed to collection and assembly of data; AA and ALS contributed to data analysis and interpretation; All authors contributed to manuscript writing and final approval of manuscript.

Corresponding author

Correspondence to Brice Ilharreborde.

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Conflict of interest

All authors have completed the ICMJE uniform disclosure form. Pr. B Ilharreborde is a consultant for Zimmer Biomet, Medtronic and Implanet. The remaining authors have no conflict of interest to declare.

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Ethical approval

The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013). The study was approved by the institutional board and informed consent was taken from all the patients.

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Simon, AL., Angelliaume, A., Happiette, A. et al. Halo-gravity traction followed by definitive fusion in severe early onset scoliosis: results of a trunk analysis based on biplanar 3D reconstructions. Eur Spine J 30, 3540–3549 (2021). https://doi.org/10.1007/s00586-021-06986-y

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  • DOI: https://doi.org/10.1007/s00586-021-06986-y

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