A Retrospective Study to Compare the Efficacy of Preoperative Halo-Gravity Traction and Postoperative Halo-Femoral Traction After Posterior Spinal Release in Corrective Surgery for Severe Kyphoscoliosis

Abstract

Background: This retrospective clinical study aimed to compare the efficacy of preoperative halo-gravity traction with postoperative halo-femoral traction after posterior spinal release in corrective surgery for patients with severe kyphoscoliosis. Material/Methods: A retrospective clinical study included patients who underwent elective corrective surgery for severe kyphoscoliosis (N=60) between 2013 and 2015. Two patient groups were compared, the postoperative halo-femoral traction after posterior spinal release (R-HF) group (N=30) and the preoperative halo-gravity traction (HGT) group (N=30). Demographic and clinicopathological data included age, gender, Cobb angle, degree of spinal curvature, history of osteotomy, and etiological factors. Patients in the two study groups were matched. Postoperative surgical outcome was evaluated by the radiographic coronal Cobb angle, global kyphosis, coronal balance, and the sagittal vertical axis (SVA). Clinical outcome was assessed using the Scoliosis Research Society Outcomes Questionnaire (SRS-22). Results: The preoperative Cobb angle was similar between the R+HF group and the HGT group (123.5±12.7° vs. 123.1±14.1°; P=0.909). Following postoperative traction, a significantly higher correction rate was found in the R+HF group than the HGT group (31.8±7.8% vs. 19.3±12.9%; P=0.001). The postoperative correction rate in the R+HF group was significantly higher than the HGT group (44.7±7.8% vs. 39.0±12.8%; P=0.042). In both study groups, the postoperative SRS-22 scores were significantly improved with no statistical difference between the two groups, and no neurological complications occurred. Conclusions: Patients with severe kyphoscoliosis who underwent postoperative halo-femoral traction after posterior spinal release achieved satisfactory radiographic correction.

Radiological and Pulmonary Results of Surgical Treatment of Severe Idiopathic Scoliosis Using Preoperative Halo Gravity Traction Compared with Less Invasive Temporary Internal Distraction in Staged Surgery in Adolescents

“…PF in severe idiopathic scoliosis patients was notably compromised in this investigation, potentially elevating the risks associated with corrective surgery and impacting the patients' daily functionality, growth, development, and appearance [36,44]. Moreover, aligned with the outcomes of our analysis, extensive literature has established a robust linkage between curve correction and PF enhancement [5,12,14,25,32,44]: enhancing respiratory capacity before scoliosis correction may mitigate postoperative complications. Surgical interventions for severe scoliosis using HGT or staged procedures have substantially decreased apical deformity translation by 70% and bolstered postoperative PF in severe scoliosis cases [5,12,14,25,32,45,46].…”

“…Additionally, it aids in enhancing lung function by 9% [10,15,32,34,35], an outcome that aligns with those observed in our study's Group 1 patients. A notable benefit of HGT therapy is its cost-effectiveness, requiring fewer financial investments compared with implant utilization or the application of magnetically controlled growing rods for internal temporary traction, as discussed in various studies [11][12][13][14]20]. Nevertheless, a direct comparison of overall treatment expenses is challenging due to variations influenced by a country's healthcare system and insurance framework.…”

“…The preferred treatment approach for severe and rigid spinal curvatures is the utilization of preoperative Halo gravity traction (HGT) [9][10][11][12][13][14][15]. However, various alternative methods have also been introduced for managing severe spinal deformities, such as temporary internal distraction (TID) and its various adaptations, anterior release (AR), posterior release (PR), and thoracoplasty with rib osteotomy (TP), as well as different forms of three-column osteotomies like pedicle subtraction osteotomy (PSO) and vertebrectomy (commonly known as vertebral column resection (VCR)) [16][17][18][19][20][21][22][23][24][25].…”

No Benefits in Using Magnetically Controlled Growing Rod as Temporary Internal Distraction Device in Staged Surgical Procedure for Management of Severe and Neglected Scoliosis in Adolescents

“…Various protocols for preoperative traction exist, and the course of treatment with traction can also differ [ 5 , 6 , 7 , 8 , 9 , 10 , 15 ]. Many studies have confirmed the legitimacy and need for the use of HGT in the treatment of severe deformities [ 21 ].…”

“…The treatment of severe (and often neglected) spinal deformities in children and adolescents can be a real challenge for the spine surgeon and the entire team, as it is associated with a higher risk of intra- and postoperative complications [ 1 , 2 , 3 , 4 ]. Severe spinal curvatures have long been treated with preoperative Halo spinal traction, in its various variations, such as Halo femoral traction (HFT), Halo pelvic traction (HPT), or Halo gravity traction (HGT) [ 5 , 6 , 7 , 8 , 9 , 10 ]. With the introduction of modern magnetically controlled growing rods in spinal surgery, they have also been adopted and described in the literature as temporary internal distraction devices for the treatment of severe scoliosis [ 11 , 12 ].…”