Skull-femoral traction after posterior release for correction of adult severe scoliosis: efficacy and complications

Qiao, Jie; Xiao, Lingyan; Xu, Leilei; Liu, Zhen; Sun, Xu; Qian, Bangping; Zhu, Zezhang; Qiu, Yong

doi:10.1186/s12891-018-2207-3

Cited by 8 publications

(5 citation statements)

References 25 publications

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“…The inclusion of skull-femoral traction among potentially dangerous maneuvers was based on studies reporting either frequent MEP deteriorations probably caused by spinal cord ischemia because of stretching of the anterior spinal artery 17 or neurologic deficits associated with this procedure. 18 The relationship between intraoperative MEP changes and the risk of IPNMDs was null in 424 surgeries, showing no significant MEP deteriorations. This finding is consistent with the general consensus that false-negatives are extremely rare in MEP-NIOM.…”

Section: Discussionmentioning

confidence: 96%

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Analysis of Intraoperative Motor Evoked Potential Changes and Surgical Interventions in 513 Pediatric Spine Surgeries

Segura¹,

Talarico²,

Miranda³

et al. 2022

Journal of Clinical Neurophysiology

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Purpose:(1) To determine probabilities of immediate postoperative new motor deficits after no, reversible, and irreversible motor evoked potentials (MEP) deteriorations and (2) to calculate the same outcome considering whether MEP deteriorations were followed by surgical interventions in the absence of confounding factors.Methods: We analyzed MEPs from 513 surgeries. Four-limb MEPs were evoked by transcranial electrical stimulation. Baseline recordings were obtained before skin incision and updated before instrumentation. Motor evoked potentials deteriorations were considered significant whenever they showed a persistent, reversible, or irreversible amplitude decrease of .80% of the baseline values.Results: Nine patients showed postoperative new motor deficits. Probabilities of postoperative new motor deficits were null, 2.8%, and 36.8% with no, reversible, and irreversible MEP deteriorations, respectively. The risk of immediate postoperative new motor deficits was significantly lower (P ¼ 0.0002) in reversible MEP compared with irreversible MEP deteriorations. In patients showing reversible/irreversible MEP deteriorations in the absence of confounding factors, surgical interventions compared with nonsurgical interventions significantly decreased the risk of immediate postoperative new motor deficits (P ¼ 0.0216).Conclusions: This study shows that probabilities of immediate postoperative new motor deficits increase with the severity of intraoperative MEP changes. In addition, our results support the value of surgical interventions triggered by MEP deteriorations to reduce postoperative adverse motor outcomes.

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Section: Discussionmentioning

confidence: 96%

“…The inclusion of skull–femoral traction among potentially dangerous maneuvers was based on studies reporting either frequent MEP deteriorations probably caused by spinal cord ischemia because of stretching of the anterior spinal artery 17 or neurologic deficits associated with this procedure. 18…”

Section: Discussionmentioning

confidence: 99%

Analysis of Intraoperative Motor Evoked Potential Changes and Surgical Interventions in 513 Pediatric Spine Surgeries

Segura¹,

Talarico²,

Miranda³

et al. 2022

Journal of Clinical Neurophysiology

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“…HFT is a foundation for intraoperative orthopaedic treatments and reduces the risks of neurological problems; the patient's neurological status is often examined and evaluated. Compared to HGT, HFT could offer more efficient correction of severe spinal deformities, and these factors were considered as follows [ 25 , 26 ]: (1) HFT provided more traction forces and better release for both major and compensatory curves and required less traction time compared to HGT; (2) HFT could let patients obtain more effective traction time and efficacy, especially under the condition of sleep or muscle relaxation; and (3) HFT could be maintained during surgery for further release and correction,…”

Section: Discussionmentioning

confidence: 99%

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

Zhang,

Deng,

Guo

et al. 2023

J Orthop Surg Res

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Background Many patients with neuromuscular scoliosis (NMS) experience a variety of difficult medical problems that aggravate the development effects of progressive scoliosis and pelvic obliquity (PO). The objective of the current study was to assess the safety and effectiveness of multi-rod posterior correction only (MRPCO) with halo-femoral traction (HFT) for the management of adult NMS (> 100°) with severe PO. Methods From 2012 to 2017, 13 adult patients who suffered from NMS (> 100°) with severe PO underwent MRPCO with HFT. The radiography parameters in a sitting position, such as the coronal Cobb angle of the main curve, the PO and the trunk shift (TS), were measured at the preoperative, postoperative and final follow-up stages. The preoperative and final follow-up assessment of the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) was taken. Results The average follow-up span was 68.15 ± 6.78 months. There was decreased postoperative coronal Cobb angle with an average mean of 125.24° ± 11.78° to 47.55° ± 12.10°, with a correction rate of 62.43%; the PO was reduced to 6.25° ± 1.63° from 36.93° ± 4.25° with a correction rate of 83.07%; the TS was reduced to 2.41 cm ± 1.40 cm from 9.19 cm ± 3.07 cm. There was significant improvement in all parameters compared to the preoperative data. The VAS score reduced from 4.77 ± 0.93 to 0.69 ± 0.75, and the ODI score reduced from 65.38 ± 16.80 to 28.62 ± 12.29 at the final follow-up. Conclusions Treatment of adult NMS (> 100°) with severe PO could be safe and effective with MRPCO with HFT. In order to obtain the optimum sitting balance, this could reduce the prevalence of complications and rectify the curvature and the correction of PO.

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“…Currently, there are several options for the treatment of severe and rigid scoliosis, including surgical correction after traction [6], anterior release and posterior spinal fusion [7], high grade osteotomy [5], and one-stage posterior spinal correction and fusion [8]. Halo-gravity, halopelvic, and skull-femoral traction are usually used to treat severe and rigid scoliosis before or during surgery [9][10][11][12]. Although this technique has a certain corrective effect, patients may not tolerate the long treatment cycle, as well as traction-related complications with an incidence of 16% to 28% [5,12,13].…”

Section: Introductionmentioning

confidence: 99%

“…Halo-gravity, halopelvic, and skull-femoral traction are usually used to treat severe and rigid scoliosis before or during surgery [9][10][11][12]. Although this technique has a certain corrective effect, patients may not tolerate the long treatment cycle, as well as traction-related complications with an incidence of 16% to 28% [5,12,13]. Besides, several studies have found that preoperative traction does not increase the final correction rate compared with one-stage spinal fusion.…”

Section: Introductionmentioning

confidence: 99%

Apical region correction and global balance: a 3-rods surgical strategy for the treatment of severe and rigid scoliosis

Jiao

Tan

Feng

et al. 2022

BMC Musculoskelet Disord

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Background The treatment of severe and rigid scoliosis is challenging. We developed a surgical strategy for severe and rigid scoliosis since 2014. This study aimed to retrospectively analyze the safety and efficacy of apical region correction and global balance with 3 rods as a surgical strategy for the treatment of severe and rigid scoliosis. Methods A retrospective study was performed for patients with severe and rigid scoliosis who underwent one-stage posterior corrective operation using the apical region correction and global balance with 3 rods surgical strategy between February 2014 and April 2020. The inclusion criteria were as follows: [1] Cobb angle > 90°; [2] flexibility < 30%; [3] a minimum 2-year follow-up. Patients were excluded if they had a history of traction or spinal surgery. Coronal and sagittal parameters, including Cobb angle, flexibility, apex vertebra translation, trunk shift (TS), thoracic kyphosis, lumbar lordosis, and sagittal vertical axis (SVA) were measured preoperatively, postoperatively and at the final follow-up. The Scoliosis Research Society 22-item questionnaire was administered preoperatively and at the final follow-up. During the operation, one slightly-bent short rod was placed into the concave side of apical region and correction was achieved by rod-rotation and distraction. Two pre-bent long rods were placed into both sides of the scoliosis and global balance was improved by leveling the proximal thoracic vertebrae and distal lumbar vertebrae. Results A total of 41 patients were included, with an average age of 20 years (range, 12–49 years) and follow-up of 34 months (range, 24–58 months). Postoperative correction rate was 53% for scoliosis. There were 14 patients with normal kyphosis before surgery, and 28 patients with normal kyphosis at the last follow-up. 88% of the patients (23/26) with preoperative coronal imbalance (TS > 20 mm) restored coronal balance at the final follow-up. 87% of the patients (14/16) with preoperative sagittal imbalance (SVA > 40 mm) restored sagittal balance at the final follow-up. The mean operation time and blood loss were 286 min and 941 mL, respectively. No patients had neurological complications or implant failure. Conclusion The surgical strategy of apical region correction and global balance with 3 rods is a safe and effective alternative for the surgical treatment of severe and rigid scoliosis.

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Skull-femoral traction after posterior release for correction of adult severe scoliosis: efficacy and complications

Cited by 8 publications

References 25 publications

Analysis of Intraoperative Motor Evoked Potential Changes and Surgical Interventions in 513 Pediatric Spine Surgeries

Analysis of Intraoperative Motor Evoked Potential Changes and Surgical Interventions in 513 Pediatric Spine Surgeries

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

Apical region correction and global balance: a 3-rods surgical strategy for the treatment of severe and rigid scoliosis

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