The radiographic, pulmonary, and clinical outcomes of patients with severe rigid spinal deformities treated via halo‐pelvic traction

Abstract

Background The severe rigid deformity patients with pulmonary dysfunction could not tolerate complicated corrective surgery. Preoperative traction are used to reduce the curve magnitude and improve the pulmonary function before surgery, including halo-gravity traction (HGT) and halo-pelvic traction (HPT). The present study aimed to retrospectively compare the radiographic, pulmonary and clinical outcomes of preoperative HGT and HPT in severe rigid spinal deformity with respiratory dysfunction. Methods 81 cases of severe rigid kyphoscoliosis treated with preoperative traction prior to corrective surgery for spinal deformity between 2016 and 2019 were retrospectively reviewed. Two patient groups were compared, HPT group (N = 30) and HGT group (N = 51). Patient demographics, coronal and sagittal Cobb angles and correction rates, pulmonary function, traction time, osteotomy grade, and postoperative neurological complications were recorded for all cases. Results The coronal Cobb angle was corrected from 140.67 ± 2.63 to a mean of 120.17 ± 2.93° in the HGT group, and from 132.32 ± 4.96 to 87.59 ± 3.01° in the HPT group (mean corrections 15.33 ± 1.53 vs. 34.86 ± 3.11 %) (P = 0.001). The mean major sagittal curve decreased from 134.28 ± 3.77 to 113.03 ± 4.57° in the HGT group and from 129.60 ± 8.45 to 65.61 ± 7.86° in the HPT group (P < 0.001); the mean percentage corrections were 16.50 ± 2.13 and 44.09 ± 9.78 % (P < 0.001). A significant difference in the pulmonary function test results was apparent between the two groups; the mean improvements in the FVC% of the HGT and HPT groups were 6.76 ± 1.85 and 15.6 ± 3.47 % (P = 0.024). The HPT group tended to exhibit more FEV% improvement than the HGT group, but the difference was not significant (5.15 ± 2.27 vs. 11.76 ± 2.22 %, P = 0.91). Conclusions Patients with severe rigid kyphoscoliosis who underwent preoperative HPT exhibited better radiographic correction of the deformity, and pulmonary function, and required fewer osteotomies compared to the HGT group. Thus, HPT may be useful for severe rigid spinal deformity patients with pulmonary dysfunction.

Sequential Correction Using Satellite Rod for the Treatment of Severe Rigid Spinal Deformity: A Retrospective Study of 19 Cases

“…So far, there have been many surgical approaches to treat severe spinal deformities, including preoperative traction followed by posterior instrumentation, combined anterior and posterior procedure, PSO or VCR by posterior procedure [5,6,15] . PVCR has been widely reported to treat severe rigid spinal deformity.…”

Halo-external fixator frame-assisted correction to treat severe kyphotic deformity in children younger than 4 years old

“…However, there is one notable retrospective study available. 15 Chen et al compared outcomes following preoperative halo-gravity traction or halo-pelvic traction among 81 patients with severe, rigid kyphoscoliosis (Cobb angle > 100º) and found largely in favour of the halo-pelvic technique. 15 When compared to halo-gravity traction, halo-pelvic traction was associated with significantly shorter traction time, significantly better deformity correction, significantly better improvement in pulmonary function and fewer osteotomies.…”

“…13 Severe deformity may be complicated by respiratory dysfunction, and traction has also shown substantial benefit for improving preoperative respiratory function in these cases. 14,15 Traction techniques described in the literature include halo-pelvic, halo-gravity, and halo traction, accompanied by anterior release procedures as indicated. [7][8][9][10][11][12][14][15][16][17] Halo-pelvic traction was first developed by O'Brien et al in 1958 and has been shown to be very effective as part of the treatment for severe kyphosis.…”

“…14,15 Traction techniques described in the literature include halo-pelvic, halo-gravity, and halo traction, accompanied by anterior release procedures as indicated. [7][8][9][10][11][12][14][15][16][17] Halo-pelvic traction was first developed by O'Brien et al in 1958 and has been shown to be very effective as part of the treatment for severe kyphosis. 7,8,14,[16][17][18] For example, previous studies have reported significantly reduced blood loss and surgery time when comparing patients who received preoperative halo-pelvic traction to those who received surgical correction only.…”

Effects of combined adjustable Halo-pelvic fixation brace on cervical spine alignment in patients with severe rigid spinal deformity

“…The flexibility between the vertebral bodies is decreased and the spine is seriously unbalanced, seriously affecting the physical and mental health of young patients. Before the advent of internal spinal fixation, continuous Halo-pelvic traction was the optimum treatment for spinal deformity [ 4 , 5 ]. Since traction is a painful and lengthy process for patients, it is usually accompanied by complications such as pain, nail tract infection, bedsore, and cranial nerve palsy; therefore, it was gradually abandoned [ 6 , 7 ].…”