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Preoperative short-term traction prior to posterior vertebral column resection: procedure and role

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Abstract

Purpose

Severe rigid spine deformity with sharp curve can be effectively corrected by posterior vertebral column resection (PVCR). Meanwhile, high risk of this procedure also has been recognized generally. The aim of this study is to review and evaluate the role of preoperative skull-femoral traction prior to PVCR for extremely severe rigid spinal deformity with sharp angular curve >150°.

Methods

Twelve cases with extremely severe rigid deformities and sharp curves were treated by skull-femoral traction before operation. For them, the mean preoperative major scoliotic curve and kyphosis were 153° (110°–168°) and 109° (61°–180°). Continuous skull-femoral traction in supine position was started 4 weeks before operation. In the process of traction, tolerance, neurologic status, deformity changes, etc., were reviewed and documented for analysis. PVCR were performed in all these patients for final and main correction.

Results

The final traction force in the 12 cases was 63 % of body weight. After 4-week traction, the main scoliotic curve and kyphosis were decreased by 34 and 31 %. In 1 week, main scoliotic curve and kyphosis were decreased by 19 and 15 %. In 2 weeks, the major scoliosis curve was decreased by 11 %, but kyphosis was unexpectedly increased by 4 %. Deformity in the last 2 weeks was less significant than the first 2 weeks. After PVCR, the main scoliotic curve and kyphosis were improved 69 and 66 %. No permanent neurological damage occurred.

Conclusion

Preoperative skull-femoral traction effectively mitigates the neurological risks of PVCR for extremely severe rigid spinal deformity with sharp curve. During traction, scoliosis can be improved more significantly and easily than kyphosis.

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Authors and Affiliations

  1. Department of Orthopaedics, The 2nd Affiliated Hospital of Kunming Medical University, 374# Dianmian Road, Kunming, 650101, Yunnan, People’s Republic of China

    Yingsong Wang, Jingming Xie, Zhi Zhao, Tao Li, Yin Zhang, Ni Bi, Zhiyue Shi, Yunhua Cai & Yuhao Zhang

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  1. Yingsong Wang
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  2. Jingming Xie
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  3. Zhi Zhao
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  4. Tao Li
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  5. Yin Zhang
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  6. Ni Bi
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  7. Zhiyue Shi
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  8. Yunhua Cai
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  9. Yuhao Zhang
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Correspondence to Jingming Xie.

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Wang, Y., Xie, J., Zhao, Z. et al. Preoperative short-term traction prior to posterior vertebral column resection: procedure and role. Eur Spine J 25, 687–697 (2016). https://doi.org/10.1007/s00586-014-3752-6

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  • DOI: https://doi.org/10.1007/s00586-014-3752-6

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