Abstract
Aim
To investigate the efficacy and safety of temporary internal distraction corrective surgery for extremely severe scoliosis.
Methods
Eleven scoliosis patients (3 males and 8 females) with curves ≥130° (mean 148.8°; range 130°–157°) who underwent a two-stage surgery, including a posterior temporary internal distraction correction and definitive posterior spinal correction with posterior pedicle screw instrumentation from 2008 to 2011 were retrospectively reviewed. Minimum follow-up was 2-years (mean 41.8 months; range 27.0–63.0 months). The analysis focused on the impact of temporary internal distraction on curve correction, pulmonary function tests (PFTs), complications and surgical outcomes. Neurosurveillance of sensory (somatosensory-evoked potentials) and motor (motor-evoked potentials) potential was performed in all cases. Posterior instrumentation was used in all patients.
Results
After the use of internal distraction, the preoperative major curve (mean 148.8°; range 130°–157°) was corrected to a mean of 79° (range 63°–87°), the T5–T12 kyphosis Cobb angle (mean 79°; range 30°–97°) was corrected to a mean of 59° (range 20°–75°), the coronal imbalance (mean 0.8 cm; range −3.6 to 2.8 cm) was improved to a mean of 0.6 cm (range −1.5 to 2.0 cm), the forced vital capacity percentage (FVC%) was improved from 59.3 ± 11.6 to 68.7 ± 13.7, and the forced expiratory volume in 1 s (FEV1%) was improved from 61.4 ± 13.6 to 71.3 ± 9.3. The average increase in body height was 6.7 cm, and the dorsum razor was corrected to 3–5 cm. During definitive surgery, the final major curves were corrected to a mean of 55° (range 32°–72°), the T5–T12 kyphosis Cobb was corrected to 35° (range 15°–68°), the coronal imbalance was improved to 0.5 cm (range −1.2 to 1.8 cm), the FVC% was improved to 71.2 ± 8.3, the FEV1% was improved to 76.3 ± 16.7, the increase in body height was 3.1 cm, and the dorsum razor was corrected to 1–3 cm. The mean interval time between the two surgeries was 3.5 months. None of the patients exhibited postoperative neurologic deficits or infections. No instrument complications were found during the final follow-up.
Conclusions
Temporary internal distraction in a two-stage corrective surgery provided patients who had extremely severe and rigid scoliosis, an effective and safe solution for scoliosis without significant complications.
Similar content being viewed by others
References
Inal-Ince D, Savci S, Arikan H, Saglam M, Vardar-Yagli N, Bosnak-Guclu M, Dogru D (2009) Effects of scoliosis on respiratory muscle strength in patients with neuromuscular disorders. Spine J 9:981–986. doi:10.1016/j.spinee.2009.08.451
Fletcher ND, Larson AN, Richards BS, Johnston CE (2011) Current treatment preferences for early onset scoliosis: a survey of POSNA members. J Pediatr Orthop 31:326–330. doi:10.1097/BPO.0b013e31820f77a0
Cheng X, Ma H, Tan R, Wu J, Zhou J, Zou D (2012) Two-stage posterior-only procedures for correction of severe spinal deformities. Arch Orthop Trauma Surg 132:193–201. doi:10.1007/s00402-011-1415-1
Xie JM, Zhang Y, Wang YS, Bi N, Zhao Z, Li T, Yang H (2014) The risk factors of neurologic deficits of one-stage posterior vertebral column resection for patients with severe and rigid spinal deformities. Eur Spine J 23:149–156. doi:10.1007/s00586-013-2793-6
Jeszenszky D, Haschtmann D, Kleinstuck FS, Sutter M, Eggspuhler A, Weiss M, Fekete TF (2014) Posterior vertebral column resection in early onset spinal deformities. Eur Spine J 23:198–208. doi:10.1007/s00586-013-2924-0
Leatherman KD (1973) The management of rigid spinal curves. Clin Orthop Relat Res:215–224
Charry O, Koop S, Winter R, Lonstein J, Denis F, Bailey W (1994) Syringomyelia and scoliosis: a review of twenty-five pediatric patients. J Pediatr Orthop 14:309–317
Farley FA, Song KM, Birch JG, Browne R (1995) Syringomyelia and scoliosis in children. J Pediatr Orthop 15:187–192
Bridwell KH (2006) Decision making regarding Smith-Petersen vs. pedicle subtraction osteotomy vs. vertebral column resection for spinal deformity. Spine 31:S171–S178. doi:10.1097/01.brs.0000231963.72810.38
Lenke LG, O’Leary PT, Bridwell KH, Sides BA, Koester LA, Blanke KM (2009) Posterior vertebral column resection for severe pediatric deformity: minimum two-year follow-up of thirty-five consecutive patients. Spine 34:2213–2221. doi:10.1097/BRS.0b013e3181b53cba
Papadopoulos EC, Boachie-Adjei O, Hess WF, Sanchez Perez-Grueso FJ, Pellise F, Gupta M, Lonner B, Paonessa K, Faloon M, Cunningham ME, Kim HJ, Mendelow M, Sacramento C, Yazici M (2013) Early outcomes and complications of posterior vertebral column resection. Spine J. doi:10.1016/j.spinee.2013.03.023
Xie J, Li T, Wang Y, Zhao Z, Zhang Y, Bi N (2012) Change in Cobb angle of each segment of the major curve after posterior vertebral column resection (PVCR): a preliminary discussion of correction mechanisms of PVCR. Eur Spine J 21:705–710. doi:10.1007/s00586-011-1985-1
Lu GH, Wang XB, Wang B, Li J, Kang YJ, Deng YW, Liu WD (2010) Complications of one stage posterior vertebral column resection for the treatment of severe rigid spinal deformities. Zhonghua wai ke za zhi [Chinese Journal of Surgery] 48:1709–1713
Li C, Fu Q, Zhou Y, Yu H, Zhao G (2012) Posterior extrapleural intervertebral space release combined with wedge osteotomy for the treatment of severe rigid scoliosis. Spine 37:E647–E654. doi:10.1097/BRS.0b013e318250042b
Xie J, Wang Y, Zhao Z, Zhang Y, Si Y, Yang Z, Liu L, Lu N (2011) One-stage and posterior approach for correction of moderate to severe scoliosis in adolescents associated with Chiari I malformation: is a prior suboccipital decompression always necessary? Eur Spine J 20:1106–1113. doi:10.1007/s00586-011-1717-6
Sponseller PD, Takenaga RK, Newton P, Boachie O, Flynn J, Letko L, Betz R, Bridwell K, Gupta M, Marks M, Bastrom T (2008) The use of traction in the treatment of severe spinal deformity. Spine 33:2305–2309. doi:10.1097/BRS.0b013e318184ef79
Lewis SJ, Gray R, Holmes LM, Strantzas S, Jhaveri S, Zaarour C, Magana S (2011) Neurophysiological changes in deformity correction of adolescent idiopathic scoliosis with intraoperative skull-femoral traction. Spine 36:1627–1638. doi:10.1097/BRS.0b013e318216124e
Cheung JP, Samartzis D, Cheung KM (2014) A novel approach to gradual correction of severe spinal deformity in a pediatric patient using the magnetically-controlled growing rod. Spine J 14:e7–e13. doi:10.1016/j.spinee.2014.01.046
Buchowski JM, Bhatnagar R, Skaggs DL, Sponseller PD (2006) Temporary internal distraction as an aid to correction of severe scoliosis. J Bone Joint Surg Am 88:2035–2041. doi:10.2106/JBJS.E.00823
Buchowski JM, Skaggs DL, Sponseller PD (2007) Temporary internal distraction as an aid to correction of severe scoliosis. Surgical technique. J Bone Joint Surg Am 89 (Suppl 2) Pt.2:297–309. doi: 10.2106/JBJS.G.00163
Tan R, Ma HS, Zou DW, Wu JG, Chen ZM, Zhou XF, Zhou JW (2012) Surgical treatment of severe scoliosis and kyphoscoliosis by stages. Chin Med J (Engl) 125:81–86
Quanjer PH, Tammeling GJ, Cotes JE, Pedersen OF, Peslin R, Yernault JC (1993) Lung volumes and forced ventilatory flows. Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society. Eur Respir J Suppl 16:5–40
Smith-Petersen MN, Larson CB, Aufranc OE (1969) Osteotomy of the spine for correction of flexion deformity in rheumatoid arthritis. Clin Orthop Relat Res 66:6–9
Koller H, Zenner J, Gajic V, Meier O, Ferraris L, Hitzl W (2012) The impact of halo-gravity traction on curve rigidity and pulmonary function in the treatment of severe and rigid scoliosis and kyphoscoliosis: a clinical study and narrative review of the literature. Eur Spine J 21:514–529. doi:10.1007/s00586-011-2046-5
Gonzalez C, Ferris G, Diaz J, Fontana I, Nunez J, Marin J (2003) Kyphoscoliotic ventilatory insufficiency: effects of long-term intermittent positive-pressure ventilation. Chest 124:857–862
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
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
Rizzi PE, Winter RB, Lonstein JE, Denis F, Perra JH (1997) Adult spinal deformity and respiratory failure. Surgical results in 35 patients. Spine 22:2517–2530 discussion 2531
Vitale MG, Matsumoto H, Bye MR, Gomez JA, Booker WA, Hyman JE, Roye DP Jr (2008) A retrospective cohort study of pulmonary function, radiographic measures, and quality of life in children with congenital scoliosis: an evaluation of patient outcomes after early spinal fusion. Spine 33:1242–1249. doi:10.1097/BRS.0b013e3181714536
Weinstein SL (1999) Natural history. Spine 24:2592–2600
Koumbourlis AC (2006) Scoliosis and the respiratory system. Paediatr Respir Rev 7:152–160. doi:10.1016/j.prrv.2006.04.009
Smiljanic I, Kovac V, Cimic M (2009) Changes in pulmonary functional parameters after surgical treatment of idiopathic scoliosis. Coll Antropol 33(Suppl 2):145–152
Zhou C, Liu L, Song Y, Liu H, Li T, Gong Q (2013) Two-stage vertebral column resection for severe and rigid scoliosis in patients with low body weight. Spine J 13:481–486. doi:10.1016/j.spinee.2012.07.008
Enercan M, Ozturk C, Kahraman S, Sarier M, Hamzaoglu A, Alanay A (2013) Osteotomies/spinal column resections in adult deformity. Eur Spine J 22(Suppl 2):S254–S264. doi:10.1007/s00586-012-2313-0
Wang Y, Zhang Y, Zhang X, Huang P, Xiao S, Wang Z, Liu Z, Liu B, Lu N, Mao K (2008) A single posterior approach for multilevel modified vertebral column resection in adults with severe rigid congenital kyphoscoliosis: a retrospective study of 13 cases. Eur Spine J 17:361–372. doi:10.1007/s00586-007-0566-9
Lenke LG, Sides BA, Koester LA, Hensley M, Blanke KM (2010) Vertebral column resection for the treatment of severe spinal deformity. Clin Orthop Relat Res 468:687–699. doi:10.1007/s11999-009-1037-x
Suk SI, Kim JH, Kim WJ, Lee SM, Chung ER, Nah KH (2002) Posterior vertebral column resection for severe spinal deformities. Spine 27:2374–2382. doi:10.1097/01.BRS.0000032026.72156.1D
Wang Y, Xie J, Zhao Z, Zhang Y, Li T, Si Y (2013) Changes in CSF flow after one-stage posterior vertebral column resection in scoliosis patients with syringomyelia and Chiari malformation type I. J Neurosurg Spine 18:456–464. doi:10.3171/2013.1.SPINE12366
Akhtar OH, Rowe DE (2008) Syringomyelia-associated scoliosis with and without the Chiari I malformation. J Am Acad Orthop Surg 16:407–417 16/7/407 [pii]
Watanabe K, Lenke LG, Bridwell KH, Kim YJ, Hensley M, Koester L (2010) Efficacy of perioperative halo-gravity traction for treatment of severe scoliosis (≥100°). J Orthop Sci 15:720–730. doi:10.1007/s00776-010-1523-8
Letts RM, Palakar G, Bobecko WP (1975) Preoperative skeletal traction in scoliosis. J Bone Joint Surg Am 57:616–619
Tindall GT, Flanagan JF, Nashold BS Jr (1959) Brain abscess and osteomyelitis following skull traction. A report of three cases. Arch Surg 79:638–641
Papagelopoulos PJ, Sapkas GS, Kateros KT, Papadakis SA, Vlamis JA, Falagas ME (2001) Halo pin intracranial penetration and epidural abscess in a patient with a previous cranioplasty: case report and review of the literature. Spine 26:E463–E467
Soyer J, Iborra JP, Fargues P, Pries P, Clarac JP (1999) Brain abscess following the use of skull traction with Gardner-Wells tongs. Chirurgie 124:432–434 S0001400100800173 [pii]
Sharma BS, Khosla VK, Pathak A, Mathuriya SN, Kak VK (1988) Brain abscess following insertion of skull traction. Clin Neurol Neurosurg 90:361–363
Kaye AH, Briggs M (1982) Brain abscess after insertion of skull traction. J Bone Joint Surg Br 64:500–502
Wazeka AN, DiMaio MF, Boachie-Adjei O (2004) Outcome of pediatric patients with severe restrictive lung disease following reconstructive spine surgery. Spine 29:528–534 00007632-200403010-00009 [pii], discussion 535
Sink EL, Karol LA, Sanders J, Birch JG, Johnston CE, Herring JA (2001) Efficacy of perioperative halo-gravity traction in the treatment of severe scoliosis in children. J Pediatr Orthop 21:519–524
Winter RB, Lonstein JE (2010) The Moe maximal correction test to determine true curve flexibility: a historical note with current application. Spine 35:1733–1735. doi:10.1097/BRS.0b013e3181c65179
Nepple JJ, Lenke LG (2009) Severe idiopathic scoliosis with respiratory insufficiency treated with preoperative traction and staged anteroposterior spinal fusion with a 2-level apical vertebrectomy. Spine J 9:e9–e13. doi:10.1016/j.spinee.2009.01.009
Kim YJ, Lenke LG, Bridwell KH, Cheh G, Whorton J, Sides B (2007) Prospective pulmonary function comparison following posterior segmental spinal instrumentation and fusion of adolescent idiopathic scoliosis: is there a relationship between major thoracic curve correction and pulmonary function test improvement? Spine 32:2685–2693. doi:10.1097/BRS.0b013e31815a7b17
Bonnett C, Brown JC, Perry J, Nickel VL, Walinski T, Brooks L, Hoffer M, Stiles C, Brooks R (1975) Evolution of treatment of paralytic scoliosis at Rancho Los Amigos Hospital. J Bone Joint Surg Am 57:206–215
Rinella A, Lenke L, Whitaker C, Kim Y, Park SS, Peelle M, Edwards C 2nd, Bridwell K (2005) Perioperative halo-gravity traction in the treatment of severe scoliosis and kyphosis. Spine 30:475–482 00007632-200502150-00017 [pii]
Seller K, Haas S, Raab P, Krauspe R, Wild A (2005) Preoperative halo-traction in severe paralytic scoliosis. Z Orthop Ihre Grenzgeb 143:539–543. doi:10.1055/s-2005-836750
Flierl S, Carstens C (1997) The effect of halo-gravity traction in the preoperative treatment of neuromuscular scoliosis. Z Orthop Ihre Grenzgeb 135:162–170. doi:10.1055/s-2008-1039574
Tokunaga M, Minami S, Kitahara H, Isobe K, Nakata Y, Moriya H (2000) Vertebral decancellation for severe scoliosis. Spine 25:469–474
Miladi L, Journe A, Mousny M (2013) H3S2 (3 hooks, 2 screws) construct: a simple growing rod technique for early onset scoliosis. Eur Spine J 22(Suppl 2):S96–105. doi:10.1007/s00586-012-2379-8
Thompson GH, Akbarnia BA, Campbell RM Jr (2007) Growing rod techniques in early-onset scoliosis. J Pediatr Orthop 27:354–361. doi:10.1097/BPO.0b013e3180333eea
Pratt RK, Webb JK, Burwell RG, Cummings SL (1999) Luque trolley and convex epiphysiodesis in the management of infantile and juvenile idiopathic scoliosis. Spine 24:1538–1547
Akbarnia BA, Breakwell LM, Marks DS, McCarthy RE, Thompson AG, Canale SK, Kostial PN, Tambe A, Asher MA, Growing Spine Study G (2008) Dual growing rod technique followed for three to eleven years until final fusion: the effect of frequency of lengthening. Spine 33:984–990. doi: 10.1097/BRS.0b013e31816c8b4e
Emans JB, Caubet JF, Ordonez CL, Lee EY, Ciarlo M (2005) The treatment of spine and chest wall deformities with fused ribs by expansion thoracostomy and insertion of vertical expandable prosthetic titanium rib: growth of thoracic spine and improvement of lung volumes. Spine 30:S58–S68
Zhang JG, Wang W, Qiu GX, Wang YP, Weng XS, Xu HG (2005) The role of preoperative pulmonary function tests in the surgical treatment of scoliosis. Spine 30:218–221 00007632-200501150-00011 [pii]
Di Silvestre M, Bakaloudis G, Lolli F, Vommaro F, Martikos K, Parisini P (2008) Posterior fusion only for thoracic adolescent idiopathic scoliosis of more than 80 degrees: pedicle screws versus hybrid instrumentation. Eur Spine J 17:1336–1349. doi:10.1007/s00586-008-0731-9
Yamin S, Li L, Xing W, Tianjun G, Yupeng Z (2008) Staged surgical treatment for severe and rigid scoliosis. J Orthop Surg Res 3:26. doi:10.1186/1749-799X-3-26
Suh SW, Modi HN, Yang J, Song HR, Jang KM (2009) Posterior multilevel vertebral osteotomy for correction of severe and rigid neuromuscular scoliosis: a preliminary study. Spine 34:1315–1320. doi:10.1097/BRS.0b013e3181a028bc
Lonner BS, Murthy SK, Boachie-Adjei O (2005) Single-staged double anterior and posterior spinal reconstruction for rigid adult spinal deformity: a report of four cases. Spine J 5:104–108
Conflict of interest
There are no conflicts of interest.
Author information
Authors and Affiliations
Corresponding authors
Rights and permissions
About this article
Cite this article
Hu, HM., Hui, H., Zhang, HP. et al. The impact of posterior temporary internal distraction on stepwise corrective surgery for extremely severe and rigid scoliosis greater than 130°. Eur Spine J 25, 557–568 (2016). https://doi.org/10.1007/s00586-015-4013-z
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-015-4013-z