Intraoperative Traction Research Articles

Expert consensus on the clinical application of cortical bone trajectory for lumbar pedicle screws: results from a modified Delphi study.

A modified Delphi study. This study sought to establish expert consensus on the use of cortical bone trajectory (CBT) for lumbar pedicle screws. The CBT technique is widely used in the treatment of various degenerative lumbar diseases because it reduces surgical time, soft tissue exposure, and blood loss; improves biomechanical stability; and allows for faster patient recovery. However, as an emerging surgical technique, CBT remains controversial in terms of preoperative evaluation methods, key surgical techniques, complication prevention and treatment, postoperative follow-up, and other aspects, resulting in unclear indications and contraindications for some doctors and posing great challenges to the steady promotion of this technique. From May 2021 to August 2021, panelists were chosen to collect expert feedback using the modified Delphi method, and 74 spine surgeons from across China agreed to participate. Four rounds were conducted: one in-person meeting and three subsequent survey rounds. Each question received at least 70.0% agreement, indicating a consensus. The grade A, B, and C recommendation were defined as having ≥90.0%, 80.0%-89.9%, and 70.0%-79.9% agreement on each question, respectively. The panelist group consisted of 74 experts, and 72, 70, and 69 questionnaires were collected in three rounds, respectively. In total, 24 questions with 59 options reached consensus after the Delphi rounds, including indications (adjacent vertebral diseases after lumbar internal fixation) and contraindications (previous surgery or bone destructive diseases lead to the destruction or absence of bone in the lamina or isthmus); advantages (intraoperative traction of paravertebral soft tissue is small) and disadvantages (not three-column fixation.); preoperative evaluation; complications; and postoperative follow-up evaluation, of CBT. The modified Delphi method achieved expert consensus on the clinical use of CBT for lumbar pedicle screws. This consensus document establishes clear guidelines for indications, contraindications, surgical techniques, and postoperative management, thereby enhancing clinical decision-making and promoting the safe and effective use of CBT. While the initial study focused on Chinese surgeons, future research will seek to validate and expand these findings from a broader international perspective.

Poster 192: The Incidence and Breadth of Postoperative Pudendal Nerve Palsy and Its Relationship to Table Traction During Hip Arthroscopy With a Perineal Post

Objectives: Pudendal nerve palsy (PNP) is a poorly characterized but common postoperative complication of hip arthroscopy (HA) with a perineal post that can result in external genital numbness and sexual dysfunction in both men and women. Previous attempts to quantify the incidence of these symptoms have relied on patient-initiated reports, chart review, unvalidated questionnaires or have neglected the female experience altogether – failures which likely underestimate the incidence of this complication. We aimed to describe the incidence of postoperative PNP, the breadth of symptoms patient experience and their duration, as well as establish the relationship between PNP and table traction. Methods: We utilized a multisurgeon prospective cohort of HA patients a single academic center. All patients underwent primary unilateral hip arthroscopy, osteochondroplasty and labral repair in a supine position with a perineal post. Patients with preexisting PNP symptoms, including sexual dysfunction, and those who were not sexually active were excluded. Intraoperative traction duration and force were recorded using a Tekscan sensor applied to the perineal post. A PNP screening questionnaire and standardized, validated sexual function questionnaires were administered confidentially to patients at 2 weeks, 6 weeks, 3 months, and 6 months postoperatively. Patient-reported hip function scores (iHOT-33) were completed preoperatively and at 6 months postoperatively. Results: A total of 100 patients were enrolled. The mean age was 36.2 ± 9.4 years old, 56 patients (56%) were male. The mean traction duration was 80 ± 19 minutes. In the acute postoperative period, 77 patients (77%) experienced symptoms consistent with PNP. The most common sensory symptom described was perineal numbness (n = 77, 77%), followed by paresthesias (n=26, 26%). Seventeen men (17%) and 13 women (13%) reported symptoms of sexual dysfunction postoperatively, in the form of erectile dysfunction (men) or reduced sexual lubrication/dyspareunia/anorgasmia (women). Of patients who experienced PNP symptoms (n = 77), 21% had symptoms resolve by 6 weeks, 71% by 3 months, 90% by 6 months. Two male patients (3.6%) had persistent erectile dysfunction beyond 6 months postoperatively. Persistence of PNP symptoms beyond 6 weeks was associated with lower 33-item International Hip Outcome Tool (iHOT-33) scores at 6 months (mean difference: 18.4 [95% CI: 6.5-30.4], p = 0.003). Analysis of the calibrated sensor data to establish the relationship between traction force, pressure, and duration with PNP is pending. Conclusions: In this preliminary analysis of a planned 100-patient cohort, patients experienced a high rate of PNP and sexual dysfunction symptoms following HA with perineal post, far higher than previous reports. Most symptoms resolved within the first 3 months postoperatively. Anticipated results from the sensor data within this ongoing study are likely to provide insight into the relationship between traction force and/or duration and PNP incidence. A postless HA setup could be considered as an alternative given the described morbidity.

The effect of preoperative botulinum toxin a injection on traction force during hernia repair: a prospective, single-blind study, intra-patient comparison using contralateral side as a control

PurposeVentral hernias are a common complication of laparotomy, posing challenges particularly when primary fascial closure is unattainable. Although chemical component separation using preoperative botulinum toxin A (BTX) injections has emerged as a promising adjunct, objective evidence of its efficacy remains limited. This study aimed to objectively assess the effect of preoperative BTX on traction force during ventral hernia repair.MethodsA prospective, single-blind study was conducted on patients with midline incisional hernias following liver transplantation. BTX was administered unilaterally, and the traction force required to medially advance the anterior rectus sheath was measured intraoperatively. Pre- and post-injection CT scans were analyzed for changes in hernia size and LAW muscle measurements. Statistical analyses were performed to evaluate traction force differences between BTX-injected and uninjected sides.ResultsTen patients underwent hernia repair with primary fascial closure achieved in all cases. Comparison of pre- and post-injection CT scans showed no significant changes in hernia size. LAW muscle length increased by 1.8 cm, while thickness decreased by 0.2 cm. Intraoperative traction force measurements revealed a significant reduction on the BTX-injected side compared to the uninjected side (p < 0.0001). The traction force ratio on the BTX-injected to the uninjected side averaged 57%, indicating the efficacy of BTX in reducing tension.ConclusionPreoperative BTX significantly reduces traction force during ventral hernia repair, highlighting its potential as an adjunctive therapy in complex cases. While challenges remain in patient selection and outcome assessment, BTX offers a promising avenue for enhancing abdominal wall reconstruction outcomes and reducing surgical complications.

Database Review of 514 Patients with Os Odontoideum. Detailed Analysis of 258 Surgically Treated (1978-2019).

Database review (1978-2019) is to identify the cause of os odontoideum, its presentation, associated abnormalities, and management recommendations. Review of referral database of 514 patients and 258 surgically treated patients ages 4-64years. Detailed history of early childhood trauma and initial encounter record retrieval were made. Patients had dynamic motion radiographs, dynamic motion MRI and also CT to identify pathology and reducibility of craniocervical instability. Preoperative crown halo traction was made before the year 2000 except in children. Intraoperative traction with O-arm/CT documentation was made since 2001. Reducible and partially reducible cases underwent halo traction under general anesthesia distraction, dorsal stabilization, and rib graft augmentation for fusion. Later semi-rigid instrumentation and subsequently rigid instrumentation was made. Irreducible compression of cervicomedullary junction was treated with ventral decompression. The follow up was 3-20years. Database; acute worsening after trauma 262, insidious neurological deficit 252. Minimal/normal motion with neurological deficit was present in 18, previous C1-C2 fusion with worsening in 18. 28 patients of 64 without treatment worsened in 4years. An intact odontoid process was seen in 52 children of 156 who had early craniovertebral junction trauma and later developed os odontoideum. There were 174 patients with reducible lesions and partially reducible were 22. Irreducible lesions were 62. Of the reducible, 50 underwent transarticular C1-C2 fusion, 26 C1 lateral mass, and C2 pars screw fixation. 182 had occipitocervical fusion (19 had extension of previous C1-C2 fusion and 43 after transoral decompression). 62 with irreducible ventral compression of the cervicomedullary junction underwent transoral decompression; 43 had a trapped transverse ligament between the os and C2 body and 19 previous C1-C2 fusions. Compression was by the axis body, os odontoideum, and the posterior C2 arch. Syndromic and skeletal/connective tissue abnormalities were found in 86 (36%). 2 patients worsened, age 10 and 62, due to failure of semi-rigid construct. The etiology of os odontoideum is multifactorial considering the associated abnormalities, reports of congenital-familiar occurrence, and early childhood craniovertebral trauma which also plays a role in the etiology. Patients with reducible lesions require stabilization. Asymptomatic patients are at risk for later instability. Patients who underwent childhood C1-C2 fusion must be followed for later problems. The irreducibility was seen due to trapped transverse ligament, pannus, or previous dorsal C1-C2 fusion.

Intraoperative traction has a negligible time-dependent influence onpatient-reported outcomes after hip arthroscopy: a cohort study.

The aim of this study is to determine if post-operative patient-reported outcome measures (PROMs) are influenced by hip arthroscopy traction duration. Patients from a local prospective hip arthroscopy database were retrospectively analyzed. Four hip-specific PROMs were utilized: modified Harris Hip Score (mHHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sports Specific (HOS-SS), and international Hip Outcome Tool (iHOT). PROMs were collected pre-operatively and 6 months, 1 year and 2 years post-operatively. Two cohorts were created based on a cut-off corresponding to the 66th percentile for our patient cohort. Analyses were completed for each PROM at each post-operative interval with univariable statistics. Multivariable statistics were examined to identify the variables that were predictive of achieving post-operative minimal clinically important difference (MCID) at the 2-year follow-up. Overall, 222 patients met the inclusion criteria. The mean age was 32.4 ± 9.4 years, and 116 (52.3%) were female. The average traction time of the study population was 46.1 ± 12.9 min. A total of 145 patients were included in the short traction cohort (65%) with traction times of <50 min (66th percentile). No significant differences were found regarding PROM scores or MCID achievement rates between both cohorts at any post-operative period. In multivariable analyses, achievement of MCID was predicted by a decrease in traction time for all PROMs and pincer-type resection for mHSS, HOS-ADL and iHOT. There was no difference in PROMs and MCID achievement between longer and shorter traction time cohorts. On multivariable analysis, a decrease in traction time is predictive of MCID for all PROM scores and pincer-type resection was predictive of MCID for most PROM scores. Level of evidence: Level III, cohort study.

Posterior Spinal Fusion Surgery for Neuromuscular Disease Patients with Severe Scoliosis Whose Cobb Angle Was over 100 Degrees.

Background and objectives: Patients with neuromuscular diseases usually have progressive neuromuscular scoliosis (NMS), requiring invasive surgery. Some patients present with severe scoliosis at the time of consultation and are difficult to treat. Posterior spinal fusion (PSF) surgery combined with anterior release and pre- or intraoperative traction would be effective for severe spinal deformities but would be invasive. This study aimed to evaluate the outcomes of PSF-only surgery for patients with severe NMS with a Cobb angle > 100°. Materials and Methods: Thirty NMS patients (13 boys and 17 girls; mean age 13.8 years) who underwent PSF-only surgery for scoliosis with a Cobb angle > 100° were included. We reviewed the lower instrumented vertebra (LIV), duration of surgery, blood loss, perioperative complications, preoperative clinical findings, and radiographic findings, including Cobb angle and pelvic obliquity (PO) in the sitting position pre- and postoperatively. The correction rate and correction loss of the Cobb angle and PO were also calculated. Results: The mean duration of surgery was 338 min, intraoperative blood loss was 1440 mL, preoperative %VC was 34.1%, FEV1.0 (%) was 91.5%, and EF was 66.1%. There were eight cases of perioperative complications. The Cobb angle and PO correction rates were 48.5% and 42.0%, respectively. We divided the patients into two groups: the L5 group, in which the LIV was L5, and the pelvis group, in which the LIV was the pelvis. The duration of surgery and PO correction rate in the pelvis group were significantly higher than those in the L5 group. Conclusions: Patients with severe NMS demonstrated severe preoperative restrictive ventilatory impairments. PSF surgery without anterior release or any intra-/preoperative traction showed satisfactory outcomes, including acceptable scoliosis correction and improved clinical findings, even in patients with extremely severe NMS. Instrumentation and fusion to the pelvis for severe scoliosis in patients with NMS showed good PO correction and low correction loss of Cobb angle and PO, but a longer duration of surgery.

Multimodal analgesia did not improve post-operative pain scores, reduce opioid consumption or reduce length of stay following hip arthroscopy.

To determine whether different regimens of multimodal analgesia will reduce postoperative pain scores, opioid consumption, costs and hospital length-of-stay following hip arthroscopy. From 2018 to 2021, 132 patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS) were included in this prospective, single-center randomized controlled trial. Patients were randomized into four treatment groups: (1) Group 1-Control: opioid medication (oxycodone-acetaminophen 5mg/325mg, 1-2 tabs q6H as needed), Heterotopic ossification prophylaxis-Naprosyn 500mg twice daily × 3weeks); (2) Group 2-Control + postoperative sleeping aid (Zopiclone 7.5mg nightly × 7days); (3) Group 3-Control + preoperative and postoperative Gabapentin (600mg orally, 1h preoperatively; 600mg postoperatively, 8h following pre-op dose); (4) Group 4-Control + pre-medicate with Celecoxib (400mg orally, 1h preoperatively) The primary outcome was pain measured with a visual analog scale, monitored daily for the first week and every other day for 6weeks. Secondary outcomes included opioid consumption, healthcare resource use, and hospital length of stay. Patient characteristics were similar between groups. There were no statistically significant differences in pain scores between groups at any timepoint after adjusting for intra-operative traction time, intra-operative opioid administration and preoperative pain scores (p > 0.05). There were also no significant differences in the number of days that opioids were taken (n.s.) and the average daily morphine milligram equivalents consumed (n.s.). Similarly, there were no statistically significant differences in length of stay in the experimental groups, compared with the control group (n.s.). Finally, there were no differences in cost between groups (n.s.). The routine use of Zopiclone, Celecoxib and Gabapentin did not improve postoperative pain control or reduce length-of-stay following hip arthroscopy. Therefore, these medications are not recommended for routine postoperative pain control following hip arthroscopy. l.

Hip Joint Venting Decreases the Traction Force Required to Access the Central Compartment During Hip Arthroscopy

To investigate the effect of hip joint venting on the magnitude of traction force required to arthroscopically access the central compartment of the hip. Patients who underwent hip arthroscopy for femoroacetabular impingement syndrome prospectively underwent an intraoperative traction protocol. Joint space was measured on fluoroscopic images obtained at 50 and 100 lbs of axial traction in the prevented and vented state, and joint space values were normalized to millimetric values using preoperative anteroposterior pelvis radiographs. Venting was performed by inserting a large gauge spinal needle into the hip joint through the hip capsule and removing the stylet. Joint space differences were compared with paired t-tests, Wilcoxon signed-rank tests, and McNemar tests. Fifty hips in 46 patients were included. Mean joint space before venting was 7.4 ± 2.6 mm and 13.3 ± 2.8 mm at 50 and 100 lbs of traction, respectively. Mean joint space after venting was 13.9 ± 2.3 mm and 15.5 ± 2.4 mm at 50 and 100 lbs of traction, respectively. Mean differences in joint space at 50 and 100 lbs were 6.5 mm (P < .001) and 2.2 mm (P < .001), respectively. Mean joint space at 50 lbs in the vented state was significantly greater than in the pre-vented state at 100 lbs (13.9 mm vs. 13.3 mm; P= .002). The increase in joint space between 50 and 100 lbs of traction was significantly greater in the prevented state than in the vented state (5.9 mm vs 1.6 mm; P= .021). Venting the hip reduces the traction force necessary to arthroscopically visualize and instrument the central compartment of the hip by at least 50%. Further, residual negative pressurization of the hip joint remains after breaking the labral suction seal and venting effectively eliminates this phenomenon to aid in hip joint distraction at lower traction force. Level IV, case series.

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

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.

Application of an Intraoperative Limb Positioner for Adjustable Traction in Both-Column Fractures of the Acetabulum: A Technical Note with Clinical Outcome

Traction of the ipsilateral leg is usually required to facilitate fracture reduction while operating both-column acetabular fractures. However, it is challenging to maintain constant traction manually during the operation. Herein, we surgically treated such injuries while maintaining traction using an intraoperative limb positioner and investigated the outcomes. This study included 19 patients with both-column acetabular fractures. Surgery was performed after the patient's condition had stabilized, at an average of 10.4 days after injury. The Steinmann pin was transfixed to the distal femur and connected to a traction stirrup; subsequently, the construct was affixed to the limb positioner. A manual traction force was applied through the stirrup and maintained with the limb positioner. Using a modified Stoppa approach combined with the lateral window of the ilioinguinal approach, the fracture was reduced, and plates were applied. Primary union was achieved in all cases at an average of 17.3 weeks. The quality of reduction at the final follow-up was found to be excellent, good, and poor in 10, 8, and 1 patients, respectively. The average Merle d'Aubigné score at the final follow-up was 16.6. Surgical treatment of both-column acetabular fracture using intraoperative traction with a limb positioner yields satisfactory radiological and clinical outcomes.

AVALIAÇÃO RADIOGRÁFICA DE CORREÇÃO CIRÚRGICA DE ESCOLIOSE DEVIDO A PARALISIA CEREBRAL USANDO TRAÇÃO INTRAOPERATIVA E NOVA TÉCNICA DE CORREÇÃO COM TERCEIRA HASTE PROVISÓRIA

ABSTRACT Objective: Evaluate the radiographic results of patients with cerebral palsy and Lonstein and Akbarnia type II scoliosis who underwent intraoperative halofemoral traction (IFAT) and correction with a 3rd provisional nail. Methods: Retrospective case series study. Were evaluated preoperative (PRE), traction (TR), immediate (POI), and late (POT) total spine radiographs. Were verified the angular value of the main curve (COBB), pelvic obliquity (OP), trunk balance in the coronal plane (CSVA), vertical sagittal alignment (SVA), curve flexibility, and percentage of correction in the final PO. Friedam and Wilcoxon tests were performed (p&lt;0.05). Results: Twenty-one patients were included in the study, with a mean age of 16 (±4.13). There was a statistical difference when comparing COBB PRE with TRACTION to POI and POT (p=0.0001), OP in PRE with TRACTION, and between PRE and POT (p=0.0001). There was a statistical difference in coronal (CSVA) and sagittal (SVA) balance concerning PRE and POT. The percentage of correction for the main curve was 55.75% (± 11.11), and for the O P, 64.86% (± 18.04). Conclusion: The correction technique using the 3rd provisional nail technique and intraoperative traction presents a correction power of 55.75% of the proximal curve and 64% of the pelvic obliquity. In addition, it is easy to assemble, has a short surgical time, and causes little loss of correction during follow-up. Level of Evidence III B; I study a series of retrospective cases.

Postless Hip Distraction Systems Decrease the Amount of Traction Force Needed to Obtain Adequate Hip Distraction Versus a Conventional Post Hip Distractor

To directly compare hip distraction distance and traction force data for hip arthroscopy performed using a post-basedsystem versus a postless system. Adult patients undergoing primary hip arthroscopy for femoroacetabular impingement were prospectively enrolled. Before March 26, 2019, arthroscopy was performed using a post-based system. After this date, the senior author converted to using a postless system. Intraoperative traction force and fluoroscopic distraction distance were measured to calculate hip stiffness coefficients at holding traction (k-hold) and maximal traction (k-max). We used multivariable regression analysis to determine whether postless arthroscopy was predictive of lower stiffness coefficients when controlling for other relevant patient-specific factors. Hip arthroscopy was performed with a post-based system in 105 patients and with a postless system in 51. Mean holding traction force (67.5 ± 14.0 kilograms-force [kgf] vs 55.8 ± 15.3 kgf) and mean maximum traction force (96.0 ± 16.6 kgf vs 69.9 ± 14.1 kgf) were significantly lower in the postless group. On multivariable analysis, postless traction was an independentpredictor of decreased k-hold (β= -31.4; 95% confidence interval, -61.2 to -1.6) and decreased k-max (β= -90.4; 95% confidence interval, -127.8 to -53.1). Male sex, Beighton score of 0, and poor hamstring flexibility were also predictors of increased k-hold and k-max in the multivariable model. Postless traction systems decrease the amount of traction force required for adequate hip distraction for both maximal and holding traction forces when compared with post-based systems. Postless traction systems may help further reduce distraction-type neurologic injuries and pain after hip arthroscopy by lowering the traction force required to safely distract the hip. Level III, prospective cohort-historical control comparative study.

Intraoperative Traction in Scoliosis: A Safe and An Effective Tool to Achieve Better Correction

Intraoperative Traction in Scoliosis: A Safe and An Effective Tool to Achieve Better Correction

Minimally Invasive Reduction and Stabilization of Fractures of the Humeral Condyle by Skeletal Traction in Dogs: 18 Cases

AbstractClosed reduction or limited open reduction in conjunction with internal or external fixation has been recommended as the preferred treatment for many types of fractures, but this technique has rarely been recommended for articular fractures because of the need for anatomic alignment of articular surfaces. However, the proposed benefits of closed reduction should be applicable to articular fractures if appropriate reduction and implant placement can be achieved. The aim of this study was to retrospectively evaluate a surgical technique for minimally invasive reduction and stabilization of fractures of the humeral condyle by means of intraoperative traction applied to the ulna under fluoroscopic guidance. Nineteen fractures of the humeral condyle in eighteen dogs were reduced by intraoperative osteotaxis applied by traction of the ulna, minimally invasive approach to the epicondyle and fracture stabilization under fluoroscopic guidance. Postoperative reduction was considered good or excellent in most fractures. This technique can be considered as a potential option for the treatment of condylar fractures, allowing for minimally invasive reduction and stabilization, thus avoiding the need for surgical exposure of the elbow joint.

An Innovative Prone Position Using a Body-Shape Plaster Bed and Skull Traction for Posterior Cervical Spine Fracture Surgeries.

BackgroundAn innovative prone cervical spine surgical position using a body-shape plaster bed with skull traction (BSPST) was compared with the traditional prone surgical position with horseshoe headrests.MethodsA total of 47 patients, undergoing posterior cervical spine surgery for cervical spine fracture, were retrospectively classified into two groups, the BSPST group (n = 24) and the traditional group (n = 23), and underwent a posterior instrumented fusion with or without decompression. Multiple indicators were used to evaluate the advantages of the BSPST compared with the traditional position.ResultsAll the operations went smoothly. The mean recovery rate was 56.30% in the BSPST group and 48.55% in the traditional group (p = 0.454), with no significant difference. The intraoperative blood loss (177.5 ml vs. 439.1 ml, p = 0.003) and the total incidence of complications (8.3 vs. 47.8%, p = 0.004) were significantly less in the BSPST group than in the traditional group. In addition, the BSPST position provided a greater comfort level for the operators and allowed convenient intraoperative radiography.ConclusionsThis is the first study to describe a combined body-shape plaster bed and skull traction as an innovative cervical spine-prone surgical position that is simple, safe, and stable, intraoperative traction direction adjustable, reproducible, and economical for posterior cervical spine fracture surgery, and potentially other cervical and upper dorsal spine surgeries in the prone position. Additionally, this position provides the surgeons with a comfortable surgical field and can be easily achieved in most orthopedic operation rooms.

Predicting the impact of intraoperative halo-femoral traction from preoperative imaging in neuromuscular scoliosis.

Intraoperative traction (ITx) has been demonstrated to be a useful adjunct intervention at the time of posterior spinal fusion (PSF) for the treatment of severe neuromuscular scoliosis (NMS) to improve the coronal spinal deformity and pelvic obliquity. The purpose of this study is to determine if preoperative flexibility radiographs can predict the amount of spinal deformity and pelvic obliquity correction at final follow-up. This was a retrospective analysis of a single-surgeon series who underwent PSF to the pelvis with adjunct ITx for NMS. Database query identified 76 NMS patients, of which 41 met inclusion criteria. Demographic, radiographic and operative data were analyzed. Of the 41 study patients, 56% (n = 23) were male and mean age at surgery was 13.6years. Mean follow-up of 4.1years (minimum follow-up 2years). 35 patients had cerebral palsy, 5 patients were syndromic, and 1 patient had myelomeningocele. The average preoperative weight was 35kg and all were wheelchair ambulators. Total traction applied on average was 49% of the preoperative body weight. Mean preoperative coronal deformity was 91° which improved to 43° at final follow-up (53% correction). Push-supine imaging had the strongest correlation to major coronal deformity outcome at final follow-up (r2 = 0.87, p ≤ 0.0001). Compared to push-supine imaging, there was a mean greater coronal deformity correction of 18 ± 10° (p ≤ 0.0001) at final follow-up. To predict the final coronal deformity, the regression equation was final Cobb angle = 1.13085 + preop push-supine Cobb angle × 0.68830. Mean preoperative pelvic obliquity was 34° which improved to 12° at final follow-up (65% correction). Push-supine imaging had the strongest correlation to pelvic obliquity outcome at final follow-up (r2 = 0.59, p = 0.0001). Compared to push-supine imaging, there was a mean greater pelvic obliquity correction of 3 ± 10° (p = 0.0857) at final follow-up. The regression equation was final POB = 6.42096 + preop push-supine POB × 0.36675. Mean preoperative kyphosis was 70° and 52° at final follow-up (26% correction). The results of this study demonstrated for preoperative planning that the push-supine flexibility radiograph is most predictive of the coronal deformity and of the pelvic obliquity correction. At final follow-up in this NMS population, there was a mean greater improvement of 18° for coronal deformity versus preoperative push-supine imaging and 3° for pelvic obliquity versus preoperative push-supine imaging. At the time of PSF, ITx is an effective adjunct technique to improve coronal deformity and POB for NMS producing 53% coronal correction, 65% POB correction, and 26% kyphosis correction. IV.

Intraoperative Traction May Induce Acute Onset Dysphagia With Diffuse Idiopathic Skeletal Hyperostosis After Anterior Cervical Discectomy

Diffuse idiopathic skeletal hyperostosis (DISH) is a systemic bone-forming disease, and its pathogenesis remains unknown. Moreover, the incidence of DISH increases with age. DISH may be an age-related disorder that occurs more frequently in degenerative spines than in healthy spines. Most patients with DISH of the cervical spine are asymptomatic; however, mechanical compression of the esophagus by the cervical spine can induce dysphagia, hoarseness, and dyspnea. In most cases, dysphagia progresses slowly. Most cases of postoperative dysphagia after anterior cervical spine surgery occurred within 1 month, and most patients recovered spontaneously. Severe dysphagia is relatively uncommon. Here, we report a case of acute-onset dysphagia with DISH that occurred immediately after anterior cervical discectomy. We should consider the possibility of dysphagia occurring immediately after anterior cervical discectomy in patients with DISH, even in those without dysphagia before surgery. Furthermore, surgical treatment for severe postoperative dysphagia associated with DISH may be a good option.

Pediatric cervical kyphosis in the MRI era (1984-2008) with long-term follow up: literature review.

Pediatric cervical kyphosis in the MRI era (1984-2008) with long-term follow up: literature review.

Efficacy of Routine Intraoperative Cranio-Femoral Traction in Surgical Treatment of Adolescent Idiopathic Scoliosis Curves Measuring Between 50° and 90°.

Retrospective Comparative Study, Level III. In patients with scoliosis >90°, cranio-femoral traction (CFT) has been shown to obtain comparable curve correction with decreased operative time and blood loss. Routine intraoperative CFT use in the treatment of AIS <90° has not been established definitively. This study investigates the effectiveness of intraoperative CFT in the treatment of AIS between 50° and 90°, comparing the magnitude of curve correction, blood loss, operative time, and traction-related complications with and without CFT. 73 patients with curves less than 90° were identified, 36 without and 37 with cranio-femoral traction. Neuromuscular scoliosis and revision surgery were excluded. Age, preoperative Cobb angles, bending angles, and curve types were recorded. Surgical characteristics were analyzed including number of levels fused, estimated blood loss, operative time, major curve correction (%), and degree of postoperative kyphosis. Patients with traction had significantly higher preoperative major curves but no difference in age or flexibility. Lenke 1 curves had significantly shorter operative time and improvement in curve correction with traction. Among subjects with 5 to 8 levels fused, subjects with traction had significantly less EBL. Operative time was significantly shorter for subjects with 5-8 levels and 9-11 levels fused. Curves measuring 50°-75° showed improved correction with traction. Intraoperative traction resulted in shorter intraoperative time and greater correction of major curves during surgical treatment of adolescent idiopathic scoliosis less than 90°. Strong considerations should be given to use of intraoperative CFT for moderate AIS.

Trochanteric Femur Fractures: Application of Skeletal Traction during Surgery Does Not Alter Soft-Tissue Microcirculation.

Background and Objectives: Wound infections provoked by alterations in microcirculation are major complications in the treatment of trochanteric femur fractures. Surgical fracture fixation on a traction table is the gold standard for treatment, but the effect on tissue microcirculation is unknown. Microcirculation could be impaired by the pull on the soft-tissue or by a release of vasoactive factors. We hypothesized that intraoperative traction impairs soft-tissue microcirculation. Materials and Methods: In 22 patients (14 women, eight men), average age 78 years (range 36–96 ± 14), with trochanteric femur fractures, non-invasive laser-Doppler spectrophotometry was used to assess oxygen saturation, hemoglobin content, and blood flow in the skin and subcutaneous tissue before and after application of traction. Measurements were recorded in nine locations around the greater trochanter at a depth of 2, 8, and 15 mm before and after fracture reduction by traction. Results: No differences were found in any depth with traction compared to without (oxygen saturation: p = 0.751, p = 0.308, and p = 0.955, haemoglobin content: p = 0.651, p = 0.928, and p = 0.926, blood flow: p = 0.829, p = 0.866, and p = 0.411). Conclusion: In this pilot study, the application of traction does not affect skin and subcutaneous microcirculation in the surgery of proximal femur fractures.