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Efficacy of perioperative halo-gravity traction for treatment of severe scoliosis (≥100°)

  • Original Article
  • Published:
Journal of Orthopaedic Science

Abstract

Background

There have been no standardized surgical options for severe scoliotic curvatures ≥100°. Halo-gravity traction is a viable option for surgical treatment of severe scoliosis. The aim of this study was to evaluate the efficacy and safety of perioperative halo-gravity traction for scoliosis curves ≥100° with respect to radiographic outcomes and clinical complications.

Methods

A total of 21 scoliosis patients with ≥100° curves (average 118.7°; range 100°-158°) with a minimum 2-year follow-up (average 41.8 months; range 24.0-97.0 months) who underwent spinal instrumented fusion using perioperative halo-gravity traction were analyzed. Diagnoses were neuromuscular scoliosis (n = 10), idiopathic (n = 9), and congenital (n = 2). In all, 15 patients were treated by the anterior release procedure followed by final posterior fusion and 6 patients by posterior fusion alone. Six patients had only preoperative traction preceding posterior fusion alone, 6 patients only staged traction between anterior release and final posterior fusion, and 9 patients had both preoperative traction preceding anterior release and staged traction preceding final posterior fusion. The average overall traction period in all patients was 67 days (range 10–78 days).

Results

Radiographic outcomes demonstrated 51.3% correction of the major Cobb angle, 40 mm correction of apical vertebral translation, 76 mm increase of T1-S1 length, and 20.7% increase of space available for lungs at the ultimate follow-up (all comparisons P < 0.05). Preoperative traction demonstrated 27.5% correction of the major curve Cobb angle, 51.5 mm increase of T1-S1 length, 14.9% increase of space available for the lungs (all comparisons P < 0.05). Staged traction after anterior release demonstrated 37.2% correction of the major curve Cobb angle, 26.1 mm correction of apical vertebral translation, 56.5 mm increase of T1-S1 length, 14.2% increase of space available for the lungs (all comparisons P < 0.05). There were only two patients with a pin-site problem, and one required débridement. There were no neurological deficits or clinical complications.

Conclusions

Scoliosis patients with ≥100° curves can be managed successfully by corrective fusion surgery concomitant with perioperative halo-gravity traction without significant complications.

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Niigata University Medical and Dental General Hospital, Niigata, Japan

    Kei Watanabe

  2. Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S Euclid Avenue, Campus Box 8233, St. Louis, MO, 63110, USA

    Lawrence G. Lenke, Keith H. Bridwell & Linda Koester

  3. Shriners Hospital for Children — St. Louis Unit, St. Louis, MO, USA

    Marsha Hensley

  4. Columbia University Medical Center, New York, NY, USA

    Yongjung J. Kim

Authors
  1. Kei Watanabe
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  2. Lawrence G. Lenke
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  3. Keith H. Bridwell
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  4. Yongjung J. Kim
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  5. Marsha Hensley
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  6. Linda Koester
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Watanabe, K., Lenke, L.G., Bridwell, K.H. et al. Efficacy of perioperative halo-gravity traction for treatment of severe scoliosis (≥100°). J Orthop Sci 15, 720–730 (2010). https://doi.org/10.1007/s00776-010-1523-8

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  • DOI: https://doi.org/10.1007/s00776-010-1523-8

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