Posterior-only surgical correction with heavy halo-femoral traction for the treatment of extremely severe and rigid adolescent idiopathic scoliosis (> 130°)

Abstract

Introduction

The treatment of extremely severe and rigid spinal deformities was a great surgical challenge. Pulmonary impairment often occurred, which increased the challenges to already daunting surgical approaches. The present study was performed to evaluate the safety and efficacy of posterior-only surgical correction with heavy halo-femoral traction (HFT) for the treatment of extremely severe and rigid adolescent idiopathic scoliosis (AIS) of more than 130°.

Materials and methods

From 2010 to 2017, 11 patients suffered from extremely severe and rigid AIS of more than 130° underwent posterior-only surgical correction with HFT. The preoperative mean coronal Cobb angle of major curve was 139.01° ± 5.83°, and the mean flexibility was 17.21% ± 3.33%; the mean angle of thoracic kyphosis (TK) and lumbar lordosis (LL) were 65.02° ± 7.21° and 39.05° ± 4.08°, respectively; the mean trunk shift (TS) and sagittal vertical axis (SVA) were 3.3 ± 0.97 cm and 3.97 ± 1.16 cm, respectively; moreover, the percent forced vital capacity (FVC%) and percent forced expiratory volume in 1 s (FEV1%) were 50.08% ± 6.07% and 53.46% ± 5.96%, respectively; the mean body height and weight were 140.09 ± 4.95 cm and 37 ± 4.34 kg, respectively.

Results

The mean duration of surgery was 335.91 ± 48.31 min and blood loss was 1590 ± 520.1 ml. The average period of follow-up was 32.18 ± 8.17 months. After heavy HFT, the mean coronal Cobb angle of major curve was reduced to 82.98° ± 6.91° with correction rate of 40.39%. After posterior-only surgical correction, the mean coronal Cobb angle was further reduced to 51.17° ± 5.4° with correction rate of 63.27%. The postoperative mean TK, LL, TS and SVA were improved to 23.85° ± 5.14°, 44.95° ± 2.26°, 1.32 ± 0.72 cm and 1.42 ± 0.83 cm, respectively. At the final follow-up, the corrective loss rate of Cobb angle was only 0.72%; moreover, the mean FVC% and FEV1% were increased to 65.45% ± 5.29% and 69.08% ± 5.32% with improvement of 15.36% and 15.62%, respectively; the mean body height and weight were increased to 154.45 ± 5.32 cm and 45 ± 4.02 kg with improvement of 14.36 cm and 8 kg, respectively. The spinal cord function was stable, and there were no new neurological symptoms after correction.

Conclusions

Posterior-only surgical correction with heavy HFT could be safe and effective for the treatment of extremely severe and rigid AIS of more than 130° in reducing the incidence of complications and greatly improving curve correction.

This is a preview of subscription content, access via your institution.

Fig. 1

References

  1. 1.

    Chen Z, Rong L (2016) Comparison of combined anterior-posterior approach versus posterior-only approach in treating adolescent idiopathic scoliosis: a meta-analysis. Eur Spine J 25(2):363–371

    CAS  Article  Google Scholar 

  2. 2.

    Hero N, Vengust R, Topolovec M (2017) Comparative analysis of combined (first anterior, then posterior) versus only posterior approach for treating severe scoliosis: a mean follow up of 8.5 years. Spine 42(11):831–837

    Article  Google Scholar 

  3. 3.

    Yang C, Zheng Z, Liu H, Wang J, Kim YJ, Cho S (2016) Posterior vertebral column resection in spinal deformity: a systematic review. Eur Spine J 25(8):2368–2375

    Article  Google Scholar 

  4. 4.

    Lenke LG, Newton PO, Sucato DJ, Shufflebarger HL, Emans JB, Sponseller PD, Shah SA, Sides BA, Blanke KM (2013) Complications after 147 consecutive vertebral column resections for severe pediatric spinal deformity: a multicenter analysis. Spine 38(2):119–132

    Article  Google Scholar 

  5. 5.

    Riley MS, Lenke LG, Chapman TM Jr, Sides BA, Blanke KM, Kelly MP (2018) Clinical and radiographic outcomes after posterior vertebral column resection for severe spinal deformity with five-year follow-up. J Bone Joint Surg Am 100(5):396–405

    Article  Google Scholar 

  6. 6.

    Mehrpour S, Sorbi R, Rezaei R, Mazda K (2017) Posterior-only surgery with preoperative skeletal traction for management of severe scoliosis. Arch Orthop Trauma Surg 137(4):457–463

    Article  Google Scholar 

  7. 7.

    Hamzaoglu A, Ozturk C, Aydogan M, Tezer M, Aksu N, Bruno MB (2008) Posterior only pedicle screw instrumentation with intraoperative halo-femoral traction in the surgical treatment of severe scoliosis (> 100 degrees). Spine 33(9):979–983

    Article  Google Scholar 

  8. 8.

    Zhang HQ, Wang YX, Guo CF, Tang MX, Chen LQ, Liu SH, Wang YF, Chen J (2011) Posterior-only surgery with strong halo-femoral traction for the treatment of adolescent idiopathic scoliotic curves more than 100°. Int Orthop 35(7):1037–1042

    Article  Google Scholar 

  9. 9.

    Zhang HQ, Gao QL, Ge L, Wu JH, Liu JY, Guo CF, Liu SH, Lu SJ, Li JS, Yin XH, Li F (2012) Strong halo-femoral traction with wide posterior spinal release and three dimensional spinal correction for the treatment of severe adolescent idiopathic scoliosis. Chin Med J (Engl) 125(7):1297–1302

    Google Scholar 

  10. 10.

    Deng A, Zhang HQ, Tang MX, Liu SH, Wang YX, Gao QL (2017) Posterior-only surgical correction of dystrophic scoliosis in 31 patients with neurofibromatosis Type 1 using the multiple anchor point method. J Neurosurg Pediatr 19(1):96–101

    Article  Google Scholar 

  11. 11.

    Zhang HQ, Deng A, Liu SH, Chen LQ, Guo CF, Tang MX, Wu JH, Liu JY, Chen J (2011) Adult thoracolumbar or lumbar scoliosis with Chiari malformation and syringomyelia: a retrospective study of correction and fusion strategies. Arch Orthop Trauma Surg 131(4):475–480

    Article  Google Scholar 

  12. 12.

    Zhang H, Gao Q, Wang Y, Liu S, Guo C, Tang M, Lu S, Li J (2011) Clinical evaluation of indirect decompression treatments for degenerative adult idiopathic scoliosis. Arch Orthop Trauma Surg 131(12):1639–1647

    Article  Google Scholar 

  13. 13.

    Koller H, Zenner J, Gajic V, Meier O, Ferraris L, Hitzl W (2012) The impact of halo-gravity traction on curve rigidity and pulmonary function in the treatment of severe and rigid scoliosis and kyphoscoliosis: a clinical study and narrative review of the literature. Eur Spine J 21(3):514–529

    Article  Google Scholar 

  14. 14.

    Newton PO, Faro FD, Gollogly S, Betz RR, Lenke LG, Lowe TG (2005) Results of preoperative pulmonary function testing of adolescents with idiopathic scoliosis. A study of six hundred and thirty-one patients. J Bone Joint Surg Am 87(9):1937–1946

    Article  Google Scholar 

  15. 15.

    Smiljanic I, Kovac V, Cimic M (2009) Changes in pulmonary functional parameters after surgical treatment of idiopathic scoliosis. Coll Antropol 33(Suppl 2):145–152

    PubMed  Google Scholar 

  16. 16.

    Vitale MG, Matsumoto H, Bye MR, Gomez JA, Booker WA, Hyman JE, Roye DP Jr (2008) A retrospective cohort study of pulmonary function, radiographic measures, and quality of life in children with congenital scoliosis: an evaluation of patient outcomes after early spinal fusion. Spine 33(11):1242–1249

    Article  Google Scholar 

  17. 17.

    Lao L, Weng X, Qiu G, Shen J (2013) The role of preoperative pulmonary function tests in the surgical treatment of extremely severe scoliosis. J Orthop Surg Res 8:32

    Article  Google Scholar 

  18. 18.

    Lonner BS, Auerbach JD, Estreicher M, Milby AH, Kean KE (2009) Video-assisted thoracoscopic spinal fusion compared with posterior spinal fusion with thoracic pedicle screws for thoracic adolescent idiopathic scoliosis. J Bone Joint Surg Am 91(2):398–408

    Article  Google Scholar 

  19. 19.

    Suk SI, Kim JH, Kim WJ, Lee SM, Chung ER, Nah KH (2002) Posterior vertebral column resection for severe spinal deformities. Spine 27(21):2374–2382

    Article  Google Scholar 

  20. 20.

    Sponseller PD, Takenaga RK, Newton P, Boachie O, Flynn J, Letko L, Betz R, Bridwell K, Gupta M, Marks M, Bastrom T (2008) The use of traction in the treatment of severe spinal deformity. Spine 33(21):2305–2309

    Article  Google Scholar 

  21. 21.

    Bonnett C, Brown JC, Perry J, Nickel VL, Walinski T, Brooks L, Hoffer M, Stiles C, Brooks R (1975) Evolution of treatment of paralytic scoliosis at Rancho Los Amigos Hospital. J Bone Joint Surg Am 57:206–215

    CAS  Article  Google Scholar 

  22. 22.

    Qiao J, Xiao L, Xu L, Liu Z, Sun X, Qian B, Zhu Z, Qiu Y (2018) Skull-femoral traction after posterior release for correction of adult severe scoliosis: efficacy and complications. BMC Musculoskelet Disord 19(1):277

    Article  Google Scholar 

  23. 23.

    Xie J, Wang Y, Zhao Z, Zhang Y, Si Y, Li T, Yang Z, Liu L (2012) Posterior vertebral column resection for correction of rigid spinal deformity curves greater than 100°°. J Neurosurg Spine 17(6):540–551

    Article  Google Scholar 

Download references

Acknowledgements

Not applicable.

Funding

The study was supported by the Natural Science Foundation of Hunan Province, China (NO. 2020JJ4873) and key research and development program of Hunan Province, China (NO. 2017SK2062). The funding bodies had no role in the design of the study or in collection, analysis, interpretation or presentation of data.

Author information

Affiliations

Authors

Contributions

HQZ was involved in critical revision of the manuscript, statistical expertise and performing most of the analyses presented in the paper. AD was involved in study design, data analysis and interpretation, writing the manuscript and critical revision of the manuscript. CFG was involved in data collection, preliminary data analysis and interpretation, critical revision of the manuscript and statistical expertise. MXT was involved in study conception and design, data analysis and interpretation, writing the manuscript, critical revision of the manuscript, supervision and administrative support. EA was involved in study conception and design, data collection, development of data collection instruments and critical revision of the manuscript. All authors approved the final manuscript.

Corresponding author

Correspondence to Ang Deng.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The Ethics Committee in Xiangya Hospital of Central South University approved the study. All methods were performed in accordance with the relevant guidelines and regulations. Written informed consent was acquired from each of the patients (or their parents and legal guardians) to authorize treatment, imageology findings, and photographic documentation. The patients (or their parents and legal guardians) consented to the publication of their pictures as well as their anonymous and clustered data.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Zhang, HQ., Deng, A., Guo, CF. et al. Posterior-only surgical correction with heavy halo-femoral traction for the treatment of extremely severe and rigid adolescent idiopathic scoliosis (> 130°). Arch Orthop Trauma Surg (2021). https://doi.org/10.1007/s00402-020-03720-z

Download citation

Keywords

  • Extremely severe
  • Rigid
  • Adolescent idiopathic scoliosis
  • Halo-femoral traction
  • Posterior-only