Intraoperative traction in neuromuscular scoliosis surgery improves major curve correction when fusing to L5

Tøndevold, Niklas; Bari, Tanvir Johanning; Andersen, Thomas; Gehrchen, Martin

doi:10.1007/s43390-020-00268-1

Cited by 6 publications

(8 citation statements)

References 26 publications

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“…2,9,12 In this study, greater curve correction was observed in the traction group, which had greater pelvic obliquity, though not statistically significant. In this case, however, there is a similarity with the Tøndevold et al study 11 in which neither group obtained a notable change in pelvic obliquity, which may be explained by the greater rigidity of the curvature in the traction group. 11 The literature states that surgeries in patients with NMS may have the instrumentation extended either cranially (proximal thoracic spine, normally T1 or T2), to correct thoracic kyphosis, or caudally, which may be limited to the lumbar spine or include the pelvis in cases of increased pelvic obliquity.…”

Section: Discussionsupporting

confidence: 79%

“…In this case, however, there is a similarity with the Tøndevold et al study 11 in which neither group obtained a notable change in pelvic obliquity, which may be explained by the greater rigidity of the curvature in the traction group. 11 The literature states that surgeries in patients with NMS may have the instrumentation extended either cranially (proximal thoracic spine, normally T1 or T2), to correct thoracic kyphosis, or caudally, which may be limited to the lumbar spine or include the pelvis in cases of increased pelvic obliquity. 2,11 In this study, in the group with ISST, 2 (22.2%) of the 9 surgeries started in T2, but in 8 (88.8%), the arthrodesed levels started in T4, and the fixation did not extend more cranially due to the low kyphosis index.…”

Section: Discussionsupporting

confidence: 79%

“…The decisive factor for a surgical indication was that the progression of the disease was more severe and earlier, with a high preoperative Cobb angle (86.28º ± 25.51 -ISST vs. 67.15º ± 13.35 -Group without ISST), with mean ages of 13.78±3.27 and 16.88±5.64 years, respectively. Other studies like ours also reported greater preoperative Cobb angles in the group where ISST was used 7,10,11 for the higher correction potential afforded by the method. The study by Tøndevold et al 11 also evaluated the correction index, based on preoperative radiographs in flexion, for which they found a statistically significant difference between the two groups.…”

Section: Discussionsupporting

confidence: 64%

“…Other studies like ours also reported greater preoperative Cobb angles in the group where ISST was used 7,10,11 for the higher correction potential afforded by the method. The study by Tøndevold et al 11 also evaluated the correction index, based on preoperative radiographs in flexion, for which they found a statistically significant difference between the two groups. This index was not evaluated in our study, but despite the Cobb correction having been greater in the group with ISST, there was no statistical significance.…”

Section: Discussionsupporting

confidence: 64%

“…11 The literature states that surgeries in patients with NMS may have the instrumentation extended either cranially (proximal thoracic spine, normally T1 or T2), to correct thoracic kyphosis, or caudally, which may be limited to the lumbar spine or include the pelvis in cases of increased pelvic obliquity. 2,11 In this study, in the group with ISST, 2 (22.2%) of the 9 surgeries started in T2, but in 8 (88.8%), the arthrodesed levels started in T4, and the fixation did not extend more cranially due to the low kyphosis index. As regards caudal fixation, in the group with traction there was a predominance of lumbar fixation, between L4 and L5 (66.7%) and only 2 iliac fixations (22.2%), agreeing with the surgical indication due to the greater angle of pelvic obliquity present in these cases.…”

Section: Discussionmentioning

confidence: 99%

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Analysis of Patients Submitted to Surgical Treatment for Neuromuscular Scoliosis With and Without Intraoperative Traction

Nunes¹,

Zanotto²,

Lima³

et al. 2022

Coluna/Columna

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Objectives: To compare the surgical treatment of neuromuscular scoliosis (NMS) with and without intraoperative skull-skeletal traction (ISST) in terms of the degree of curve correction, surgical time, hospitalization time, screw density, use of blood products,and complications. Methods: A comparative retrospective study, in which we analyzed the medical records and radiographs of 17 patients who underwent surgical treatment for neuromuscular scoliosis (NMS). They were divided into two groups, with 9 and 8 patients operated with and without ISST, respectively, at a referral hospital specialized in the treatment of spinal deformitiesfrom 2019 to 2021. The categorical variables were analyzed using the Chi-squared test. Results: Among the 17 patients included in the study, there was a higher prevalence of women in the group without ISST (6 and 2) and of men in group with ISST (5 and 3). The ages of the patients in the two groups ranged from 8-19 years and from 11-29 years, respectively. The screw density used in the traction group averaged 66.33%±8.49 and 82.63%±17.25 in the non-traction group, a statistically significant differencewith a P-value of 0.036. The average percent correction was 76.81%±15.61 in the traction group as compared to an average of 66.39%±12.99 in the non-traction group. In addition, there were complications in 1 patient in each of the groups. Conclusions: Surgical treatment for NMS with ISST allows surgery using fewer blood products to maintain the same hematimetric level in the postoperative period. ISST also allows the use of a lower screw density to correct more severe deformities. Level of evidence III; Comparative retrospective study.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionsupporting

confidence: 79%

Section: Discussionsupporting

confidence: 64%

Section: Discussionsupporting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Analysis of Patients Submitted to Surgical Treatment for Neuromuscular Scoliosis With and Without Intraoperative Traction

Nunes¹,

Zanotto²,

Lima³

et al. 2022

Coluna/Columna

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Risk factors for neurophysiological events related to intraoperative halo-femoral traction in spinal deformity surgery

Berends,

Stadhouder,

van Royen

et al. 2024

Eur Spine J

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Purpose This study identifies risk factors for neurophysiological events caused by intraoperative halo-femoral traction (IOHFT) in patients with adolescent idiopathic scoliosis (AIS), and neuromuscular scoliosis (NMS). Methods Neurophysiological integrity was monitored using motor evoked potentials (MEPs). IONM event was defined as a decreased MEP amplitude of more than 80% of baseline in, at least, one muscle. Time between application of IOHFT and event, affected muscles, surgical stage, and time between removal of IOHFT and recovery of MEPs were described. Characteristics (age, height, weight, diagnosis, Cobb angle, and flexibility of the curve) of patients with and without IOHFT-events were compared using analysis of variance. Binary logistic regression analyses were performed to identify predictors. Results The study included 81 patients (age 15.6 ± 2.4 years, 53 females, AIS: n = 47, NMS n = 34). IOHFT-events occurred in 11 patients (13%; AIS n = 4, NMS n = 7). IOHFTevents affecting all limbs occurred pre-incision in NMS. Events affecting only the legs occurred during all stages of surgery. Patients with IOHFT-events were smaller (p = 0.009) and had stiffer curves (p = 0.046). Height was a predictor (odds ratio, 0.941; 95% confidence interval = 0.896–0.988). All MEPs recovered after removing IOHFT. Conclusion Neurophysiologic events due to IOHFT were common, with the majority in patients with NMS. A shorter stature was a risk factor, and larger Cobb angle and stiffer curve were associated with IOHFT-events. Events occurred at any stage of surgery and involved upper and lower limbs. With an adequate response on IOHFT events, none of the patients had postoperative neurological impairments due to IOHFT.

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The use of skin traction as an intraoperative adjunct for correction during pediatric neuromuscular scoliosis correction

Coughlin,

Shah,

Gupta

et al. 2024

Eur Spine J

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Intraoperative traction in neuromuscular scoliosis surgery improves major curve correction when fusing to L5

Cited by 6 publications

References 26 publications

Analysis of Patients Submitted to Surgical Treatment for Neuromuscular Scoliosis With and Without Intraoperative Traction

Analysis of Patients Submitted to Surgical Treatment for Neuromuscular Scoliosis With and Without Intraoperative Traction

Risk factors for neurophysiological events related to intraoperative halo-femoral traction in spinal deformity surgery

The use of skin traction as an intraoperative adjunct for correction during pediatric neuromuscular scoliosis correction

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