Perioperative Halo-Gravity Traction in the Treatment of Severe Scoliosis and Kyphosis

Rinella, Anthony; Lenke, Lawrence G.; Whitaker, Camden; Kim, Yongjung J.; Park, Soo-sung; Peelle, Michael; Edwards, Charles C.; Bridwell, Keith H.

doi:10.1097/01.brs.0000153707.80497.a2

Cited by 182 publications

(131 citation statements)

References 24 publications

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“…Others [3], on the other hand, believe that larger and stiffer curves of more than 90°or with a side bend of less than 65°s till require anterior release followed by posterior instrumentation, and often a halo-traction period; posterior-only fusion can instead be used in curves up to 90°which bend to less than 65°. Some authors [42] advocate single-stage posterior procedure for curves up to or exceeding 100°. We believe that a wide posterior release and a pedicle subtraction osteotomy at the apex of the deformity associated with a pedicle screws-only instrumentation might enable the use of posterior-only fusion also in stiffer curves.…”

Section: Discussionmentioning

confidence: 99%

“…Later, the most common treatment was anterior release with an open thoracotomy [10,13,26,44,46] followed by posterior instrumented fusion. Halo-traction between anterior release and posterior instrumentation was often applied [42]. Sometimes, in highly rigid scoliosis, this combined program was preceded by an additional posterior release [10].The correction rate of severe idiopathic curves with the combined treatment was 45-47%, using Harrington instrumentation [13] or the multiple hook construct [46], 52% using Zielke instrumentation with Harrington rod [26], and up to 67%, using anterior instrumentation and posterior hybrid construct [10].…”

Section: Introductionmentioning

confidence: 99%

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Posterior fusion only for thoracic adolescent idiopathic scoliosis of more than 80°: pedicle screws versus hybrid instrumentation

et al. 2008

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The treatment of thoracic adolescent idiopathic scoliosis (AIS) of more than 80°traditionally consisted of a combined procedure, an anterior release performed through an open thoracotomy followed by a posterior fusion. Recently, some studies have reassessed the role of posterior fusion only as treatment for severe thoracic AIS; the correction rate of the thoracic curves was comparable to most series of combined anterior and posterior surgery, with shorter surgery time and without the negative effect on pulmonary function of anterior transthoracic exposure. Compared with other studies published so far on the use of posterior fusion alone for severe thoracic AIS, the present study examines a larger group of patients (52 cases) reviewed at a longer follow-up (average 6.7 years, range 4.5-8.5 years). The aim of the study was to evaluate the clinical and radiographic outcome of surgical treatment for severe thoracic ([80°) AIS treated with posterior spinal fusion alone, and compare comprehensively the results of posterior fusion with a hybrid construct (proximal hooks and distal pedicle screws) versus a pedicle screw instrumentation. All patients (n = 52) with main thoracic AIS curves greater than 80°(Lenke type 1, 2, 3, and 4), surgically treated between 1996 and 2000 at one institution, by posterior spinal fusion either with hybrid instrumentation (PSF-H group; n = 27 patients), or with pedicle screw-only construct (PSF-S group; n = 25 patients) were reviewed. There were no differences between the two groups in terms of age, Risser's sign, Cobb preoperative main thoracic (MT) curve magnitude (PSF-H: 92°vs. PSF-S: 88°), or flexibility on bending films (PSF-H: 27% vs. PSF-S: 25%). Statistical analysis was performed using the t test (paired and unpaired), Wilcoxon test for nonparametric paired analysis, and the Mann-Whitney test for non-parametric unpaired analysis. At the last follow-up, the PSF-S group, when compared to the PSF-H group had a final MT correction rate of 52.4 versus 44.52% (P = 0.001), with a loss of -1.9°versus -11.3°( P = 0.0005), a TL/L correction of 50 versus 43% (ns), a greater correction of the lowest instrumented vertebra translation (-1.00 vs. -0.54 cm; P = 0.04), and tilt (-19°vs. -10°; P = 0.005) on the coronal plane. There were no statistically significant differences in sagittal and global coronal alignment between the two groups (C7-S1 offset: PSF-H = 0.5 cm vs. PSF-S = 0 cm). In the hybrid series (27 patients) surgery-related complications necessitated three revision surgeries, whereas in the screw group (25 patients) one revision surgery was performed. No neurological complications or deep wound infection occurred in this series. In conclusion, posterior spinal fusion for severe thoracic AIS with pedicle screws only, when compared to hybrid construct, allowed a greater coronal correction of both main thoracic and secondary lumbar curves, less loss of the postoperative correction achieved, and fewer revision surgeries. Posterior-only fusion with pedicle screws enabled a good and...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Posterior fusion only for thoracic adolescent idiopathic scoliosis of more than 80°: pedicle screws versus hybrid instrumentation

et al. 2008

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“…Sink et al [14] reported wound infection after posterior spinal fusion and loss of fixation of the inferior laminar hooks. Several perioperative complications were reported by Rinella et al [15] including temporary respiratory distress, malignant hyperthermia, coagulopathy, supraventricular tachycardia, triceps palsy, brachial plexus palsy and anterior strut graft dislodgement requiring revision anterior fusion. Long-term complications included superficial wound infections, curve progression, and rod migration.…”

Section: Discussionmentioning

confidence: 94%

“…Later, Rinella et al [15] performed a retrospective analysis of 33 patients with severe scoliosis or kyphoscoliosis. The main coronal curve had a mean of 84°(range 22°-158°).…”

Section: Discussionmentioning

confidence: 99%

Three-staged correction of severe rigid idiopathic scoliosis using limited halo-gravity traction

Koptan

ElMiligui

2011

Eur Spine J

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Introduction Despite the advantages of modern instrumentation techniques, the treatment of severe rigid idiopathic scoliosis could be very demanding. Traction can provide better, safer correction and minimize complications related to forceful intra-operative maneuvers; however, several side effects are associated with prolonged periods of traction. The aim of this work is to review the clinical and radiographic results of limited perioperative halo-gravity traction in severe rigid curves analyzing its efficacy, advantages and possible complications and comparing it to classic two staged corrections performed without traction. Methods A retrospective case control study including 47 adolescents with severe rigid idiopathic scoliosis divided into two groups; a consecutive series of 21 patients who had a three-staged correction by an anterior release, 2 weeks of halo-gravity traction then posterior instrumentation (TRN group); compared to an earlier series of 26 consecutive patients treated without traction (SAP group). The average age was 18 years ? 1 month and 16 years ? 2 months, respectively. The average preoperative dorsal and lumbar curves for (TRN) group were 106.5°and 87°, respectively, and for (SAP) group were 102°and 81°, respectively. Results Patients were followed up for an average of 6 years (range 3-8 years). A significantly better correction was achieved in (TRN) group (average 59%) compared to (SAP) group (average 47%). At final follow-up, the loss of correction had an average of 8°for (TRN) group and 11°f or (SAP) group. A shorter hospital stay was found in (SAP) group; a shorter operative time was found in (TRN) group and there was no significant difference in blood loss, early or delayed complications. Conclusions Limited halo-gravity traction is an efficient, safe modality in the treatment of severe rigid adolescent scoliosis. The application of gradual traction over a limited period of 2 weeks led to better correction, shorter operative time with no significant complications.

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“…It was thought to reduce the severity of scoliosis and improve pulmonary function before surgery. [18][19][20][21] Distinct time-dependent mechanical properties of biologic tissues play an important role in viscoelastic behaviour of deformed spines during correction by distraction. Viscoelasticity implies that the behaviour under load is time dependent and that the rate of distraction or the rate of increase in load must be carefully specified during traction procedures used to correct spinal deformities.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Halopelvic Traction for Curve Correction in Spinal Deformities

Singh¹,

Sangwan²,

Bala³

et al. 2017

IOSR JDMS

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Perioperative Halo-Gravity Traction in the Treatment of Severe Scoliosis and Kyphosis

Cited by 182 publications

References 24 publications

Posterior fusion only for thoracic adolescent idiopathic scoliosis of more than 80°: pedicle screws versus hybrid instrumentation

Posterior fusion only for thoracic adolescent idiopathic scoliosis of more than 80°: pedicle screws versus hybrid instrumentation

Three-staged correction of severe rigid idiopathic scoliosis using limited halo-gravity traction

Evaluation of Halopelvic Traction for Curve Correction in Spinal Deformities

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