Posterior-only surgical correction with heavy halo-femoral traction for the treatment of rigid congenital scoliosis associated with split cord malformation

Abstract

Background: Whether or not, prophylactic neurosurgical interventions of split cord malformation (SCM) before undertaking corrective surgery was the focus of debate. The present study was performed to evaluate the safety and efficacy of posterior-only surgical correction with heavy halo-femoral traction for the treatment of rigid congenital scoliosis (RCS) associated with SCM. Methods: From 2011 to 2017, 24 patients suffered from RCS associated with SCM underwent posterior-only surgical correction with heavy halo-femoral traction. The apex of the deformity was lumbar (n = 9), thoracic (n = 11), and thoracolumbar (n = 4). There were 13 cases of failure of segmentation; 4 cases of failure of formation and 7 cases of mixed defects. Based on SCM classification, there were 14 patients with SCM type 1 and 10 patients with SCM type 2. The Scoliosis Research Society (SRS)-22 and modified Japanese Orthopaedic Association (mJOA) scores were assessed preoperatively and at the final follow up. Results: The mean duration of surgery was 327.08 ± 43.99 min and the mean blood loss was 1303.33 ± 526.86 ml. The mean follow-up period was 20.75 ± 8.29 months. The preoperative mean coronal Cobb angle was 80.38°± 13.55°; on the bending radiograph of the convex side, the mean Cobb angle was 68.91°± 15.48°; the mean flexibility was 15.04% ± 7.11%. After heavy halo-femoral traction, the mean coronal Cobb angle was reduced to 56.89°± 13.39°. After posterior-only surgical correction, postoperative mean coronal Cobb angle was further reduced to 32.54°±11.33°. The postoperative mean correction rate was 60.51% ± 7.79%. At the final follow up, the corrective loss rate of Cobb angle was only 3.17%. The SRS-22 total score improved at the final follow-up evaluation compared with the preoperative SRS-22 total score. The spinal cord function was stable and there were no new neurological symptoms after correction. There were no significant differences between final follow-up and preoperative mJOA total scores. Conclusions: Without prophylactic neurosurgical intervention and spine-shortening osteotomy, posterior-only surgical correction with heavy halo-femoral traction could be safe and effective for the treatment of RCS associated with SCM.

Analysis of the corrective contribution of strong halo-femoral traction in the treatment of severe rigid nonidiopathic scoliosis

“…Sponseller et al [14] found that HGT did not increase the main coronal curve or sagittal plane correction in a multicenter, retrospective, nonrandomized comparison study. Compared to HGT, which has a limited traction weight, HFT can offer stronger and simultaneous traction forces [15,16]. In our study, the mean preoperative major curve was 97.99°± 11.47°, with a mean flexibility of 15.68% ± 6.65%, and it had only a 6.23% ± 1.79% improvement on the fulcrum film; however, after a mean 18.15 ± 2.01 kg (46.46% ± 5.36% of body weight) maximum traction weight for 18.26 ± 2.43 days, the average correction rate added 17.83% ± 5.41%, reaching a total of 39.74% ± 6.22% at the end of HFT.…”

Multi-rod posterior correction only with halo-femoral traction for the management of adult neuromuscular scoliosis (> 100°) with severe pelvic obliquity: a minimum 5-year follow-up

“…Nutritional supplement treatments were performed during the traction to increase body weight and improve nutritional status. Respiratory training, such as deep respiration and balloon exercise, was applied [ 12 , 13 ] .…”

Analysis of the corrective contribution of strong halo-femoral traction in the treatment of severe rigid nonidiopathic scoliosis

“…Compared to HGT, which has a limited traction weight, HFT can offer stronger and simultaneous traction forces. [15,16] In our study, the mean preoperative major curve was 97.99°±11.47°, with a mean exibility of 15.68% ±6.65%, and it had only a 6.23%±1.79% improvement on the fulcrum lm; however, after a mean 18.15±2.01-kg (46.46%±5.36% of body weight) maximum traction weight for 18.26±2.43 days, the average correction rate added 17.83%±5.41%, reaching a total of 39.74%±6.22% at the end of HFT. Similarly, Wang [7] reported 21 cases with extremely severe rigid scoliosis treated by HFT before posterior vertebral column resection.…”