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Analysis of patients with nonambulatory neuromuscular scoliosis surgically treated to the pelvis with intraoperative halo-femoral traction.

Takeshita K, Lenke LG, Bridwell KH, Kim YJ, Sides B, Hensley M

Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan. Takeshita-ort@h.u-tokyo.ac.jp

STUDY DESIGN: Retrospective case-control study. OBJECTIVES: To compare patients treated with and without intraoperative halo-femoral traction to assess neuromuscular spinal deformity correction as well as the safety of the technique. SUMMARY OF BACKGROUND DATA: Optimal sitting balance can be achieved in nonambulatory neuromuscular patients with pelvic obliquity by maneuvering a Galveston-type rod or inserting screws into the iliac wings; however, this is often clinically challenging because of the small, soft bone-stock in the pelvis of these patients. METHODS: A total of 40 patients with nonambulatory neuromuscular scoliosis were treated surgically with a T2 or T3-sacrum instrumented posterior spinal fusion. There were 20 patients (12 who underwent posterior spinal fusion-alone and 8 anterior/posterior spinal fusion) who had intraoperative halo-femoral traction performed unilaterally on the high side iliac wing compared to a control group of 20 patients (15 who underwent posterior spinal fusion-alone and 5 anterior/posterior spinal fusion) operatively treated without halo-femoral traction. Each group had 14 patients with spastic (cerebral palsy) scoliosis, and 6 with flaccid (muscular dystrophy) scoliosis deformities. Minimum follow-up for all patients was 2 years (range 3-12). RESULTS: Preoperative lumbar scoliosis averaged 87 degrees (range 30 degrees-141 degrees) in the halo-femoral traction group and 67 degrees (range 28 degrees-108 degrees) in the control group (P = 0.012). Postoperative lumbar Cobb decreased to 35 degrees (range 15 degrees-60 degrees) in the halo-femoral traction group and 32 degrees (range 4 degrees-66 degrees) in the control group (P = 0.181). Preoperative pelvic obliquity averaged 26 degrees (range 8 degrees-47 degrees) in the halo-femoral traction group and 17 degrees (range 8 degrees-44 degrees) in the control group (P = 0.017); postoperative averaged 6 degrees (range 1 degrees-23 degrees) in the halo-femoral traction group and 7 degrees (range 0 degrees-27 degrees) in the control group. Average pelvic obliquity correction was 78% in the halo-femoral traction group and 52% in the control group (P = 0.001). There were no intraoperative or postoperative halo-femoral traction apparatus-related complications noted (pin cut-out, femoral fractures, pin-sight infections, etc.). CONCLUSIONS: Intraoperative use of halo-femoral traction during the surgical treatment of patients with nonambulatory neuromuscular scoliosis provided significantly improved lumbar curve and pelvic obliquity correction. Intraoperative halo-femoral traction had no associated perioperative complications.

Published 20 September 2006 in Spine, 31(20): 2381-5.
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