Abstract
BackgroundThe severe rigid deformity patients with pulmonary dysfunction could not tolerate complicated corrective surgery. Preoperative traction are used to reduce the curve magnitude and improve the pulmonary function before surgery, including halo-gravity traction (HGT) and halo-pelvic traction (HPT). The present study aimed to retrospectively compare the radiographic, pulmonary and clinical outcomes of preoperative HGT and HPT in severe rigid spinal deformity with respiratory dysfunction.Methods81 cases of severe rigid kyphoscoliosis treated with preoperative traction prior to corrective surgery for spinal deformity between 2016 and 2019 were retrospectively reviewed. Two patient groups were compared, HPT group (N = 30) and HGT group (N = 51). Patient demographics, coronal and sagittal Cobb angles and correction rates, pulmonary function, traction time, osteotomy grade, and postoperative neurological complications were recorded for all cases.ResultsThe coronal Cobb angle was corrected from 140.67 ± 2.63 to a mean of 120.17 ± 2.93° in the HGT group, and from 132.32 ± 4.96 to 87.59 ± 3.01° in the HPT group (mean corrections 15.33 ± 1.53 vs. 34.86 ± 3.11 %) (P = 0.001). The mean major sagittal curve decreased from 134.28 ± 3.77 to 113.03 ± 4.57° in the HGT group and from 129.60 ± 8.45 to 65.61 ± 7.86° in the HPT group (P < 0.001); the mean percentage corrections were 16.50 ± 2.13 and 44.09 ± 9.78 % (P < 0.001). A significant difference in the pulmonary function test results was apparent between the two groups; the mean improvements in the FVC% of the HGT and HPT groups were 6.76 ± 1.85 and 15.6 ± 3.47 % (P = 0.024). The HPT group tended to exhibit more FEV% improvement than the HGT group, but the difference was not significant (5.15 ± 2.27 vs. 11.76 ± 2.22 %, P = 0.91).ConclusionsPatients with severe rigid kyphoscoliosis who underwent preoperative HPT exhibited better radiographic correction of the deformity, and pulmonary function, and required fewer osteotomies compared to the HGT group. Thus, HPT may be useful for severe rigid spinal deformity patients with pulmonary dysfunction.
Highlights
The severe rigid deformity patients with pulmonary dysfunction could not tolerate complicated corrective surgery
halo-gravity traction (HGT) was used for preoperative traction in the early year, but we found that the traction effect of some patients was not ideal, including poor improvement of lung function and nutritional status due to the “plateau effect”
This study aimed to retrospectively compare the therapeutic outcomes of preoperative HGT and halo-pelvic traction (HPT) prescribed for patients with severe rigid spinal deformities (Cobb angle > 100°)
Summary
The severe rigid deformity patients with pulmonary dysfunction could not tolerate complicated corrective surgery. The high incidence of pulmonary dysfunction in severe rigid deformity patients is the unavoidable problem for the surgeon during the perioperative period [1, 2]. Pulmonary dysplasia in such patients is attributable principally to the low thoracic volume; volumes during both inspiration and expiration are lower than those of normal subjects [3]. It is challenging to perform corrective surgery for extremely severe scoliosis patients, since their preoperative pulmonary dysfunction could not tolerate such complicated and long time surgery [7,8,9]. Large-angle orthopedics significantly increase the risk of postoperative neurological complications [10]
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