Efficacy of perioperative halo-gravity traction for treatment of severe scoliosis (≥100°).

BACKGROUND: There have been no standardized surgical options for severe scoliotic curvatures ≥100°. Halo-gravity traction is a viable option for surgical treatment of severe scoliosis. The aim of this study was to evaluate the efficacy and safety of perioperative halo-gravity traction for scoliosis curves ≥100° with respect to radiographic outcomes and clinical complications.
METHODS: A total of 21 scoliosis patients with ≥100° curves (average 118.7°; range 100°-158°) with a minimum 2-year follow-up (average 41.8 months; range 24.0-97.0 months) who underwent spinal instrumented fusion using perioperative halo-gravity traction were analyzed. Diagnoses were neuromuscular scoliosis (n = 10), idiopathic (n = 9), and congenital (n = 2). In all, 15 patients were treated by the anterior release procedure followed by final posterior fusion and 6 patients by posterior fusion alone. Six patients had only preoperative traction preceding posterior fusion alone, 6 patients only staged traction between anterior release and final posterior fusion, and 9 patients had both preoperative traction preceding anterior release and staged traction preceding final posterior fusion. The average overall traction period in all patients was 67 days (range 10-78 days).
RESULTS: Radiographic outcomes demonstrated 51.3% correction of the major Cobb angle, 40 mm correction of apical vertebral translation, 76 mm increase of T1-S1 length, and 20.7% increase of space available for lungs at the ultimate follow-up (all comparisons P < 0.05). Preoperative traction demonstrated 27.5% correction of the major curve Cobb angle, 51.5 mm increase of T1-S1 length, 14.9% increase of space available for the lungs (all comparisons P < 0.05). Staged traction after anterior release demonstrated 37.2% correction of the major curve Cobb angle, 26.1 mm correction of apical vertebral translation, 56.5 mm increase of T1-S1 length, 14.2% increase of space available for the lungs (all comparisons P < 0.05). There were only two patients with a pin-site problem, and one required débridement. There were no neurological deficits or clinical complications.
CONCLUSIONS: Scoliosis patients with ≥100° curves can be managed successfully by corrective fusion surgery concomitant with perioperative halo-gravity traction without significant complications.