Analysis of the corrective contribution of strong halo-femoral traction in the treatment of severe rigid nonidiopathic scoliosis

Abstract

Introduction Strong halo-femoral traction has been widely used in the field of severe rigid scoliosis correction. The objective of this study was to analyze the corrective contribution of strong halo-femoral traction in the treatment of severe rigid nonidiopathic scoliosis and discuss its meaning. Material and methods A retrospective review was performed for patients with severe rigid nonidiopathic scoliosis who were treated with halo-femoral traction in our center from December 2008 to December 2015. All cases underwent halo-femoral traction for 2 to 4 weeks before a one-stage posterior operation, and the absolute and relative contribution rates of each orthopedic factor (bending, fulcrum, traction, surgery) were analyzed. Results A total of 38 patients were included (15 males and 23 females), with a mean age of 16.4 ± 3.73 years (10–22 years) and follow-up of 55.05 ± 6.63 months (range 40–68 months). The etiology was congenital in 17 patients, neuromuscular in 14 patients, neurofibromatosis-1 in 3 patients, and Marfan syndrome in 2 patients. Congenital high scapular disease with scoliosis was found in 2 patients. The mean coronal Cobb angle of the major curve was 97.99° ± 11.47° (range 78°–124°), with a mean flexibility of 15.68% ± 6.65%. The absolute contribution rate (ACR) of bending was 27.26% ± 10.16%, the ACR of the fulcrum was 10.91% ± 2.50%, the ACR of traction was 32.32% ± 11.41%, and the ACR of surgery was 29.50% ± 9.70%. A significant difference in correction was noted between the ACRs of traction and the fulcrum (P < 0.05). Discussion Strong halo-femoral traction plays a relatively significant role in the treatment of severe rigid nonidiopathic scoliosis while decreasing the risk of operation, and it is a safe and effective method for the treatment of severe rigid nonidiopathic scoliosis.

Posterior Spinal Fusion Surgery for Neuromuscular Disease Patients with Severe Scoliosis Whose Cobb Angle Was over 100 Degrees

“…Regarding the surgical strategy for severe NMS, anterior release and posterior fusion surgery, intraoperative halo-femoral traction, and preoperative halo-gravity traction have been reported to be effective in severe scoliosis surgery, including NMS and idiopathic scoliosis [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ]. Auerbach et al reported that good PO correction in patients with NMS with larger and less flexible curves could be achieved using anterior release and posterior fusion surgery [ 21 ].…”

Preoperative Halo-Femoral Traction With Posterior Surgical Correction for the Treatment of Extremely Severe Rigid Congenital Scoliosis (Cobb Angle >120°)

“…Allogenous or autogenous bone grafts were implanted for fusion. 8,9 Statistics Analysis Normality of all data was proved using SPSS 22.0 (IBM) (Supplementary Table 1, http://links.lww.com/JAAOS/ A762). Sample size power analysis was performed using PASS 2021 (NCSS Statistical Software) (Supplementary Table 2, http://links.lww.com/JAAOS/A762).…”

“…All protocols were described in our previous studies. 8,9 Surgical Procedure During the operation, heavy HFT was maintained, and intraoperative neurophysiologic monitoring was used to carefully monitor spinal cord function. Posterior-column osteotomies were performed to correct the spinal deformity, including pedicle screw placement, release of rigid structure (facet joint, intertransverse ligaments, and softtissue contractures), distraction, compression, rod rotation, and derotation.…”