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Intraoperative traction in neuromuscular scoliosis surgery improves major curve correction when fusing to L5

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Abstract

Background

Intraoperative traction has shown improved curve correction in neuromuscular scoliosis surgery. It is found to be superior to anterior release in terms of correction of both main curve and pelvic obliquity. No previous study has examined the effect of intraoperative traction in patients without pelvic fixation.

Method

This retrospective study included 40 non-ambulatory (GMFCS 4 or above) patients with neuromuscular scoliosis undergoing surgery with bilateral segmental pedicle screw instrumentation to L5. Twenty-two consecutive patients had intraoperative Gardner-Wells tongs and skin traction (traction group), while the remaining did not (non-traction group). Inclusion criteria were minimum 2-year follow-up, complete medical records and radiographs.

Main curve (MC), pelvic obliquity (POB), T1 tilt, kyphosis, rotation, coronal and sagittal balance and preoperative bending radiographs were measured and analyzed in all patients.

Results

Both groups demonstrated roughly 60% MC correction. Preoperative MC was larger in the traction group [97° (49–126) vs. 83° (40–134); P = 0.03]. The measured correction index was almost twice as large in the traction group (1.9 vs. 1.1; P = 0.001). Mean [IQR] 2-year POB was 14° [7–40] in the traction group compared to 16° [4–60] in the non-traction group (P = 0.59). Eleven patients (50%) in the traction group compared to only four (22%) in the non-traction group had a POB within 10° at 2-year follow up (RR: 2.1; 95% CI 0.8–5.2). We found no difference in kyphosis or remaining radiographic parameters. No traction-related complications were recorded.

Conclusion

In patients with neuromuscular scoliosis undergoing instrumented fusion to the L5, we found that intraoperative traction increased the degree of MC correction and patients were more likely to achieve POB below 10° without any effects on sagittal parameters or without any detectable significant reduction on rotation.

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Funding

No external funding was received.

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Authors and Affiliations

  1. Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark

    Niklas Tøndevold, Tanvir Johanning Bari, Thomas Borbjerg Andersen & Martin Gehrchen

Authors
  1. Niklas Tøndevold
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  2. Tanvir Johanning Bari
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  3. Thomas Borbjerg Andersen
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  4. Martin Gehrchen
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Contributions

NT: substantial contributions to the conception or design of the work. Substantial contributions to the acquisition, analysis and interpretation of data. Revising the work critically for important intellectual content. Final approval of the version to be published. TJB: substantial contributions to the conception or design of the work. Substantial contributions to the analysis and interpretation of data. Revising the work critically for important intellectual content. Final approval of the version to be published. TBA: substantial contributions to the conception or design of the work. Revising the work critically for important intellectual content. Final approval of the version to be published. MG: substantial contributions to the conception or design of the work. Revising the work critically for important intellectual content. Final approval of the version to be published.

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Correspondence to Niklas Tøndevold.

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MG (institutional grants from K2M and Medtronic outside of the submitted work), the remaining authors report no conflicts of interest.

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This study was approved by the National Health and Medical authority and The National Data Protection Agency.

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This study includes no experimental investigation.

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Tøndevold, N., Bari, T.J., Andersen, T.B. et al. Intraoperative traction in neuromuscular scoliosis surgery improves major curve correction when fusing to L5. Spine Deform 9, 769–776 (2021). https://doi.org/10.1007/s43390-020-00268-1

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  • DOI: https://doi.org/10.1007/s43390-020-00268-1

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