Staged Treatment for Correction of Severe Adult Kyphoscoliosis Complicated by Severe Pulmonary Impairment: Halo-Pelvic Traction, Posterior Release Surgery, Posterior Vertebra Column Resection and Instrument Fusion

Abstract

Background Patients with kyphoscoliosis can present with a variety of chief complaints including axial back pain, concerns about cosmesis, progressively worsening respiratory function, and even neurological deficits. Correction of severe adult kyphoscoliosis remains challenging due to the severity of deformity and poor cardiopulmonary function. Direct one-stage corrective surgery can cause enormous complications and unsatisfactory outcome when dealing with patients with severe kyphoscoliosis. Preoperative halo-pelvic traction (HPT) has become popular to deal with severe scoliosis. The present study aimed to summarize the efficacy and safety of the staged strategy. Methods Patients with severe kyphoscoliosis complicated by severe pulmonary impairment who underwent staged treatment and met the inclusion and exclusion criteria from Jan 2019 to Jan 2020 were retrospectively reviewed. Data including patient demographics, major coronal curve and kyphosis, pulmonary function test results, distraction time, and complications at different stages of treatment were recorded. Results Twenty-three patients (16 male and 7 female) with severe kyphoscoliosis and severe pulmonary impairment were included in the study. The mean age of these patients was 26.2 ± 5.7 years. The mean duration of traction before posterior release surgery was 4.0 ± 1.0 months, while the duration after posterior release surgery was 4.4 ± 1.0 months. The mean follow-up was 40.4 ± 3.9 months. The main curve and kyphosis on admission were 145 ± 11.8° and 149 ± 21.7°, respectively. The main curve and kyphosis decreased to 114 ± 12.3° and 124 ± 22.9°, respectively, after HPT. The FVC and FVC% on admission were 1.44 ± 0.63 L and 39.0 ± 16.19%, respectively. The FVC and FVC% improved significantly after HPT. According to the Nash-Moe classification, the rotation of the apical vertebrae was Grade IV in every patients, and the rotation did not improve during the traction. The operative time of posterior release was 266 ± 49 min. The average bleeding of posterior release was 600 ± 242 ml. HPT was maintained after the posterior release surgery. The mean operating time of posterior correction surgery was 588 ± 53min, and the mean bleeding was 1605 ± 313ml. Finally, the correction rate of was 56.6% and 68.5% on coronal and sagittal plan, respectively. Conclusions Staged treatment is an effective and safe strategy to correct severe kyphoscoliosis complicated by severe pulmonary impairment. Preoperative HPT combined with posterior release surgery can significantly reduce spinal deformity and improve pulmonary function. Posterior vertebra column resection (PVCR) is an effective technique for correcting kyphoscoliosis, but it is a technically demanding procedure.