INTRAOPERATIVE TRACTION IN SURGERY FOR ADOLESCENT IDIOPATHIC SCOLIOSIS
https://doi.org/10.14531/ss2017.2.8-13
Abstract
Objective. To analyze the effectiveness of intraoperative traction in the treatment of adolescent idiopathic scoliosis, including in relation to the initial magnitude of scoliotic curve.
Material and Methods. Data on patients meeting the following criteria were selected from the electronic database and analyzed: idiopathic scoliosis (Lenke types I, III, V); age 10 to 20 years; surgery performed through posterior approach; hook or hybrid (using of pedicle screws only in the lumbar spine, at 2-4 levels) fixation; no previous history of spine surgery; and follow-up period at least two years.
Results. Flattening of thoracic kyphosis and alignment of lumbar lordosis during surgical correction were significantly more pronounced in the traction group. Postoperative changes in the sagittal contour of the thoracic and lumbar spine did not differ significantly between the traction and no-traction groups. Intraoperative traction was associated with significantly reduced blood loss, though operation time decreased statistically insignificantly. Normalization of the frontal imbalance in the immediate and long-term postoperative periods was different in the two groups, but these differences were insignificant. Intraoperative traction was most effective in the group with deformities of 50° to 75°, although it also increased the achieved correction in patients with scoliosis of a smaller and greater magnitude.
Conclusion. The operation performed with intraoperative traction allows achieving greater correction during an intervention and smaller loss of correction during a long follow-up period than that without a distraction influence. This applies equally to both primary and secondary curvatures.
About the Authors
Mikhail Vitalyevich Mikhaylovskiy
Novosibirsk Research Institute of Traumatology and Orthopaedics n.a. Ya.L. Tsivyan
Russian Federation
Russian Federation
Vyacheslav Viktorovich Novikov
Novosibirsk Research Institute of Traumatology and Orthopaedics n.a. Ya.L. Tsivyan
Russian Federation
Russian Federation
Mikhail Anatolyevich Sadovoy
Novosibirsk Research Institute of Traumatology and Orthopaedics n.a. Ya.L. Tsivyan; Novosibirsk State Medical University
Russian Federation
Russian Federation
Aleksandr Sergeyevich Vasyura
Novosibirsk Research Institute of Traumatology and Orthopaedics n.a. Ya.L. Tsivyan
Russian Federation
Russian Federation
Vasily Aleksandrovich Suzdalov
Novosibirsk Research Institute of Traumatology and Orthopaedics n.a. Ya.L. Tsivyan
Russian Federation
Russian Federation
References
1. Alsayegh S, LaMothe J, Letal M, Parsons D, Ferri-de-Barros F. Intraoperative skull femoral traction (ISFT) in posterior instrumentation for adolescent idiopathic scoliosis: safety and effect on perioperative care. Can J Surg. 2013;56(4 Suppl 2):S55.
2. Clark JA, Hsu LC, Yau AC. Viscoelastic behaviour of deformed spines under correction with halo pelvic distraction. Clin Orthop Relat Res. 1975;(110):90-111.
3. Cotrel Y, Dubousset J, Guillaumat M. New universal instrumentation in spinal surgery. Clin Orthop Relat Res. 1988;227:10-23.
4. Da Cunha RJ, Al Sayegh S, LaMothe JМ, Letal M, Johal H, Parsons DL, Ferri-de-Barros F. Intraoperative skull-femoral traction in posterior spinal arthrodesis for adolescent idiopathic scoliosis: the impact on perioperative outcomes and health resource utilization. Spine. 2015;40:E154-E160. DOI: 10.1097/BRS.0000000000000711.
5. Ferguson RL, Allen BL Jr. Staged correction of neuromuscular scoliosis. J Pediatr Orthop. 1983;3:555-562. DOI: 10.1097/01241398-198311000-00001.
6. Hamzaoglu A, Ozturk C, Aydogan M, Tezer M, Aksu N, Bruno MB. Posterior only pedicle screw instrumentation with intraoperative halo-femoral traction in the surgical treatment of severe scoliosis (>100 degrees). Spine. 2008;33:979-983. DOI: 10.1097/BRS.0b013e31816c8b17.
7. Huang MJ, Lenke LG. Scoliosis and severe pelvic obliquity in a patient with cerebral palsy: surgical treatment utilizing halo-femoral traction. Spine. 2001;26:2168-2170.
8. Jhaveri SN, Zeller R, Miller S, Lewis SJ. The effect of intra-operative skeletal (skull femoral) traction on apical vertebral rotation. Eur Spine J. 2009;18:352-356.
9. Keeler KA, Lenke LG, Good CR, Bridwell KH, Sides B, Luhmann SJ. Spinal fusion for spastic neuromuscular scoliosis: is anterior releasing necessary when intraoperative halo-femoral traction is used? Spine. 2010;35:E427-E433. DOI: 10.1097/BRS.0b013e3181d9527e.
10. Kulkami AG, Shah SP. Intraoperative skull-femoral (skeletal) traction in surgical correction of severe scoliosis (>80°) in adult neglected scoliosis. Spine. 2013;38:659-664. DOI: 10.1097/BRS.0b013e318277c874.
11. Kumar K. Spinal deformity and axial traction. Spine. 1996;21:653-655.
12. LaMothe JM, Al Sayegh S, Parsons DL, Ferri-de-Barros F. The use of intraoperative traction in pediatric scoliosis surgery: a systematic review. Spine Deformity. 2015;3:45-51. DOI: 10.1016/j.jspd.2014.06.007.
13. Letts RM, Palakar G, Bobecko WP. Preoperative skeletal traction in scoliosis. J Bone Joint Surg Am. 1975;57:616-619.
14. Lewis SJ, Gray R, Holmes LM, Strantzas S, Jhaveri S, Zaarour C, Magana S. Neurophysiological changes in deformity correction of adolescent idiopathic scoliosis with intraoperative skull-femoral traction. Spine. 2011;36:1627-1638. DOI: 10.1097/BRS.0b013e318216124e.
15. Mac-Thiong JM, Labelle H, Poitras B, Rivard CH, Joncas J. The effect of intraoperative traction during posterior spinal instrumentation and fusion for adolescent idiopathic scoliosis. Spine. 2004;29:1549-1554. DOI: 10.1097/01.BRS.0000131421.66635.AF.
16. Takeshita K, Lenke LG, Bridwell KH, Kim YJ, Sides B, Hensley M. Analysis of patients with nonambulatory neuromuscular scoliosis surgically treated to the pelvis with intraoperative halo-femoral traction. Spine. 2006;31:2381-2385. DOI: 10.1097/01.brs.0000238964.73390.b6.
17. Vialle R, Delecourt C, Morin C. Surgical treatment of scoliosis with pelvic obliquity in cerebral palsy: the influence of intraoperative traction. Spine. 2006;31:1461-1466. DOI: 10.1097/01.brs.0000219874.46680.87.
18. White AA, Panjabi MM, eds. Practical Biomechanics of Scoliosis and Kyphosis. Clinical Biomechanics of the Spine, 2nd ed. Philadelphia: J.B. Lippincott, 1990.
Review
For citations:
Mikhaylovskiy M.V., Novikov V.V., Sadovoy M.A., Vasyura A.S., Suzdalov V.A. INTRAOPERATIVE TRACTION IN SURGERY FOR ADOLESCENT IDIOPATHIC SCOLIOSIS. Russian Journal of Spine Surgery (Khirurgiya Pozvonochnika). 2017;14(2):8-13. https://doi.org/10.14531/ss2017.2.8-13
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