THE USE OF CRANIAL HALO TRACTION VERSUS TEMPORARY INTERNAL DISTRACTION IN STAGED SURGERY FOR SEVERE SCOLIOSIS: A COMPARATIVE STUDY

José Alberto Alves Oliveira,Antônio Cardoso Paiva,Rogério Dos Reis Visconti,Ricardo De Souza Portes Meireles,Paulo Cesar Almeida,Pedro Paschoal Cassapis Cardoso Afonso

doi:10.1590/s1808-185120212004250449

Abstract

ABSTRACT Objective: To determine which method is more effective – cranial halo traction or temporary internal distraction – in staged surgeries for patients with severe (≥ 100°) and stiff (<25% flexibility) scoliosis. Methods: A sample of 12 patients with traction and 7 patients without traction, operated on between January 2013 and December 2017. The patients’ demographic data, the type of surgery performed, complications, and coronal and sagittal alignment parameters were recorded before surgery and in the final follow-up. The data were processed in SPSS 20.0. Comparisons were made between the means (Student's t-test) and the clinical and procedure-related characteristics (likelihood ratio and Fisher's Exact tests), at a confidence level of 0.05. Results: There were no significant intergroup differences for clinical characteristics, complications or degree of correction. However, more patients in the group submitted to temporary internal distraction required vertebral resection osteotomies during definitive surgery (p<0.05). Conclusions: Based on the results, it was not possible to establish which is the most effective method, but it is suggested that staged traction may be more effective, and safer, particularly when the surgeon is less experienced, during surgery on patients with severe and stiff scoliosis. Level of evidence IV; Vase series.

Highlights

Despite the various surgical techniques and modern instrumentation systems available, surgery involving severe and stiff scoliosis with ≥100° remains challenging due to the magnitude of the deformity, and the potential for pseudoarthrosis and neurological complications.[1,2] Single-stage surgery for this type of deformity may pose a greater risk to the patient, due to implant failure caused by the high corrective forces on the fixation systems.[3]To reduce these complications, procedures are sometimes performed in more than one stage
Two patients with syndromic cases of scoliosis (Marfan syndrome and skeletal dysplasia) were selected, and three with neuromuscular etiology – one with myelomeningocele, who was submitted to traction, and two with sequelae of cerebral palsy, who were submitted to temporary internal distraction
The degree of osteotomy used in the definitive surgical procedure demonstrated that the patients not submitted to staged traction exhibited a larger number of vertebral resection osteotomies (p

Summary

Introduction

Despite the various surgical techniques and modern instrumentation systems available, surgery involving severe and stiff scoliosis with ≥100° remains challenging due to the magnitude of the deformity, and the potential for pseudoarthrosis and neurological complications.[1,2] Single-stage surgery for this type of deformity may pose a greater risk to the patient, due to implant failure caused by the high corrective forces on the fixation systems.[3]. To reduce these complications, procedures are sometimes performed in more than one stage. Traction has the advantage that it allows for gradual correction over time, which may prevent the need for aggressive osteotomies and reduce neurological injury during surgery.[4,5,6,7]

Results

Discussion

Conclusion