Role of intra-operative traction in deformity correction in neuromuscular scoliosis: a systematic review and meta-analysis.

Abstract

Intra-operative traction (IOT) has emerged as new modality for improving correction rates in scoliosis since it has the potential to reduce operative time and blood loss in neuromuscular scoliosis (NMS). The aim of this study is to describe the effects of IOT in deformity correction in NMS. The search was conducted in online electronic databases following the PRISMA guidelines. This review included studies on NMS which have described usage of IOT in deformity correction. Eight studies were included in analysis and review. There was low-to-moderate heterogeneity across the studies (I2 - 42.4 to 93.9%). All the studies used cranio-femoral traction for IOT. The final Cobb's angle in coronal plane was significantly lower in the traction group as compared to the non-traction group (SMD -0.36 95% CI -0.71 to 0). There was a trend towards better outcomes in final obliquity (SMD -0.78 95% CI -1.64 to 0.09), operative time (SMD -1.09 95% CI -2.25 to 0.08) and blood loss (SMD -0.86 95% CI significantly lower in the traction group as2.15 to 0.44) but did not reach statistical significance. IOT helped to achieve significant scoliotic curve correction in NMS compared to non-traction group. Despite the overall tendency of improved pelvic obliquity correction, reduced operative time and reduced blood loss as compared to a surgery without the use of IOT, it did not achieve statistical significance. Further studies which are prospective with a larger sample size and focussing on a particular etiology may be conducted which would validate the results. IV.