Two-stage treatment for severe spinal kyphotic deformity secondary to tuberculosis: halo-pelvic traction followed by a posterior-only approach correction

Abstract

Background and purpose Several surgical procedures are used to treat tuberculous kyphosis. However, the treatment of extreme spinal kyphosis is challenging, and associated with various complications. Halo traction has been used as an adjunctive method in the treatment of severe spinal deformities. However, there are few reports about the effectiveness of halo-pelvic traction (HPT) for the treatment of extreme spinal kyphosis secondary to tuberculosis. This study evaluated the effectiveness of halo-pelvic traction followed by a posterior-only approach correction in the treatment of severe spinal kyphosis secondary to tuberculosis. Methods The records of 19 patients with severe spinal kyphosis secondary to tuberculosis were retrospectively reviewed. All 19 patients were treated with a two-stage approach: HPT combined with posterior fusion surgery by a posterior-only approach. Radiographic parameters were measured and evaluated. America Spinal Injury Association grade (ASIA), Scoliosis Research Society outcome (SRS-22) score, and complications were also evaluated. Results There were 9 males and 10 females, with an average age of 29.7 years at the time of surgery. The average HPT duration was 10.4 weeks. The mean kyphosis angle decreased from 131.40 ± 10.7° pre-traction to 77.1 ± 7.4° post-traction (P < 0.01). The traction correction rate was 41.3%. The mean postoperative kyphosis angle was 65.7 ± 8.5°, and the surgical correction rate was 8.7%. Of the total correction, 82.6% was the result of HPT. At a mean follow-up of 26.5 months, the average kyphosis correction loss was 2.9°. The mean sagittal balance was 11.1 ± 45.2 mm before traction, − 25.0 ± 37.4 mm after traction, 7.0 ± 13 mm after surgery, and 2.8 ± 9.6 mm at the final follow-up. The mean preoperative SRS-22 score was 3.0 and postoperative was 4.2 (P < 0.01). The neurological status of most patients was improved. The total complication rate was 15.7%, including 1 neurological and 2 non-neurological complications. Conclusions HPT is effective in the management of severe spinal kyphotic deformity secondary to tuberculosis. Preoperative HPT can greatly reduce global kyphosis, and the need for corpectomy.

The Effect of Halo‐Pelvic Traction on Bone Mineral Density of Vertebrae and Corresponding Risk Factors

“…One‐stage traction of the spine and two‐stage corrective surgery is a mainstream strategy for rectifying severe spinal deformity 10 . Spinal traction causes less gravity and less movement, which can lead to loss of BMD 11 .…”

“…One-stage traction of the spine and two-stage corrective surgery is a mainstream strategy for rectifying severe spinal deformity. 10 Spinal traction causes less gravity and less movement, which can lead to loss of BMD. 11 The BMD is crucial for pedicle screw stability, especially in standard surgery for severe spinal correction using pedicle screws.…”

Tumors and infections of the growing spine

“…107 Generally, there are two main groups of surgical procedures: (1) debridement with the release of neural structures, and (2) debridement and spinal stabilization (with bone grafts and implants). 109,[111][112][113] A third kind of surgery concerns progressive kyphotic deformities in the healed phase. 114 These procedures are difficult to perform, with high risk of complications.…”

“…Early operative treatment in ST with neurologic deficits in currently being discussed; recommendation for surgery varies from surgery only for complete paraplegia to surgery in all neurologic deficits. 105 , 107 , 109 Regarding kyphotic deformity, the orthopedists are more unanimous; this problem is very important as a late sequela of ST and a crucial component of the natural history of ST, especially in the growing spine. 107 , 110 Neurologic deficits associated with kyphotic deformity can be slowly increasing (due to gradual spinal cord compression) or rapidly occurring (deformity leading to an instability episode).…”

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

“…Preoperative HPT, rst reported by O'Brien, has been widely used to treat severe rigid scoliosis as part of staged strategy [8][9][10][11]. Preoperative HPT can improve patients' pulmonary function and digestive function, reduce the curve of scoliosis, which can improve the safety and correction rate [10].…”