Comparison of radiological changes after Halo-pelvic traction with posterior spinal osteotomy versus simple posterior spinal osteotomy for severe rigid spinal deformity_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

OUYANG Beiping ¹ ,  LUO Chunshan ¹ , MA Xiangyang ² , ZOU Xiaobao ² , LU Tingsheng ¹ , CHEN Qiling ¹ , PU Xingwei ¹

1. Department of Spine Surgery, Guizhou Provincial Orthopedics Hospital, Guiyang Guizhou, 550004, P.R.China;
2. Department of Orthopedics, General Hospital of Southern Theatre Command of Chinese PLA, Guangzhou Guangdong, 510010, P.R.China;

Corresponding author：

LUO Chunshan, Email: lyz8088gk@163.com

Keywords：

Severe rigid spinal deformity; Halo-pelvic traction; posterior osteotomy

DOI：

10.7507/1002-1892.201911153

Video：

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Objective To compare the changes of scoliosis and kyphosis angles after Halo-pelvic traction with posterior spinal osteotomy versus simple posterior spinal osteotomy for severe rigid spinal deformity.Methods A clinical data of 28 patients with severe rigid spinal deformity between January 2015 and November 2017 was retrospectively analyzed. Sixteen patients were treated by Halo-pelvic traction with posterior spinal osteotomy (group A) and 12 patients were treated with posterior spinal osteotomy only (group B). There was no significant difference between the two groups (P>0.05) in gender, age, body mass index, and preoperative pulmonary function, coronal and sagittal Cobb angles, and flexibility. The operation time, intraoperative blood loss, and complications were recorded. The coronal and sagittal Cobb angles were measured on X-ray films before operation (before traction in group A), at 10 days after operation, at last follow-up in the two groups and after traction in group A. The improvement rate of deformity after traction in group A, the correction rate of deformity after operation, and the loss rate of correction at last follow-up were calculated.Results All patients were followed up 24-30 months (mean, 26.5 months). The operation time and intraoperative blood loss were significantly less in group A than in group B (t=7.629, P=0.000; t=8.773, P=0.000). In group A, 1 patient occurred transient numbness of both legs during continuous traction and 2 patients needed ventilator support for more than 12 hours. In group B, 7 patients needed ventilator support for more than 12 hours, including 1 patient with deep incision infection. The incidence of complications was 18.75% (3/16) in group A and 58.33% (7/12) in group B, and the difference between the two groups was significant (χ²=4.680, P=0.031). The coronal and sagittal improvement rates of deformity after traction in group A were 40.47%±3.60% and 40.70%±4.20%, respectively. There was no significant difference between the two groups (P>0.05) in the coronal and sagittal Cobb angles at 10 days after operation and at last follow-up, in the correction rate of deformity after operation, and in the loss rate of correction at last follow-up.Conclusion For the severe rigid spinal deformity, Halo-pelvic traction with posterior spinal osteotomy and simple posterior spinal osteotomy can obtain the same orthopedic effect and postoperative deformity correction. However, the Halo-pelvic traction can shorten operation time, reduce blood loss and incidence of perioperative complications.

Citation： OUYANG Beiping, LUO Chunshan, MA Xiangyang, ZOU Xiaobao, LU Tingsheng, CHEN Qiling, PU Xingwei. Comparison of radiological changes after Halo-pelvic traction with posterior spinal osteotomy versus simple posterior spinal osteotomy for severe rigid spinal deformity. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(7): 900-906. doi: 10.7507/1002-1892.201911153 Copy

1.	Kandwal P, Vijayaraghavan GP, Nagaraja UB, et al. Severe rigid scoliosis: review of management strategies and role of spinal osteotomies. Asian Spine J, 2017, 11(3): 494-503.
2.	Zhang Y, Hai Y, Tao L, et al. Posterior multiple-level asymmetrical ponte osteotomies for rigid adult idiopathic scoliosis. World Neurosurg, 2019, 127: e467-e473.
3.	Mallepally AR, Mahajan R, Rustagi T, et al. Is VCR necessary to correct very severe deformity? Case report and review of literature. Int J Neurosci, 2020. [Epub ahead of print].
4.	Lee BH, Hyun SJ, Han S, et al. Surgical and radiological outcomes after posterior vertebral column resection according to the surgeon’s experience. Medicine (Baltimore), 2018, 97(34): e11660.
5.	王号中, 修鹏, 汪雷, 等. 儿童及青少年脊柱畸形矫形围术期疼痛管理的研究进展. 中国修复重建外科杂志, 2019, 33(5): 644-649.
6.	Mohamed Ali Hussien, Mohamed Abdulsalam Wafa, Ahmed mohamed Elbadrawi, et al. Posterior vertebral column resection for congenital rigid spinal deformities. Current Orthopaedic Practice, 2019, 30(4): 361-369.
7.	Iyer S, Duah HO, Wulff I, et al. The use of halo gravity traction in the treatment of severe early onset spinal deformity. Spine (Phila Pa 1976), 2019, 44(14): E841-E845.
8.	Shimizu T, Lenke LG, Cerpa M, et al. Preoperative halo-gravity traction for treatment of severe adult kyphosis and scoliosis. Spine Deform, 2020, 8(1): 85-95.
9.	McIntosh AL, Brandon SR, Charles JC, et al. Halo gravity traction for severe pediatric spinal deformity: A clinical concepts review. Spine Deformity, 2019, 7(3): 395-403.
10.	Davies NR, Vasquez Rodriguez V, Remondino RG, et al. Inpatient versus outpatient halo-gravity traction in children with severe spinal deformity. Spine Deform, 2020. [Epub ahead of print].
11.	王华锋, 刘辉, 郑召民, 等. 后路脊柱截骨术与牵引辅助后路广泛松解术治疗重度脊柱畸形的比较研究. 中国骨与关节杂志, 2014, 3(12): 896-900.
12.	Koller H, Zenner J, Gajic V, et al. 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, 2012, 21(3): 514-529.
13.	Lenke LG, Sides BA, Koester LA, et al. Vertebral column resection for the treatment of severe spinal deformity. Clin Orthop Relat Res, 2010, 468(3): 687-699.
14.	Qiao J, Xiao L, Xu L, et al. Skull-femoral traction after posterior release for correction of adult severe scoliosis: efficacy and complications. BMC Musculoskelet Disord, 2018, 19(1): 277.
15.	Xie JM, Zhang Y, Wang YS, et al. The risk factors of neurologic deficits of one-stage posterior vertebral column resection for patients with severe and rigid spinal deformities. Eur Spine J, 2014, 23(1): 149-156.
16.	Takata Y, Lenke LG, Kelly MP. Posterior vertebral column resection for rigid proximal thoracic kyphoscoliosis with broken growing rods in a patient with Desbuquois dysplasia. Spine Deform, 2020, 8(1): 135-138.
17.	Riley MS, Lenke LG, Chapman TM Jr, et al. Clinical and radiographic outcomes after posterior vertebral column resection for severe spinal deformity with five-year follow-up. J Bone Joint Surg (Am), 2018, 100(5): 396-405.
18.	Yang C, Wang H, Zheng Z, et al. Halo-gravity traction in the treatment of severe spinal deformity: a systematic review and meta-analysis. Eur Spine J, 2017, 26(7): 1810-1816.
19.	Bao H, Yan P, Bao M, et al. Halo-gravity traction combined with assisted ventilation: an effective pre-operative management for severe adult scoliosis complicated with respiratory dysfunction. Eur Spine J, 2016, 25(8): 2416-2422.
20.	Smith JS, Sansur CA, Donaldson WF 3rd, et al. Short-term morbidity and mortality associated with correction of thoracolumbar fixed sagittal plane deformity: a report from the Scoliosis Research Society Morbidity and Mortality Committee. Spine (Phila Pa 1976), 2011, 36(12): 958-964.
21.	Chang DG, Yang JH, Lee JH, et al. Congenital scoliosis treated with posterior vertebral column resection in patients younger than 18 years: longer than 10-year follow-up. J Neurosurg Spine, 2016, 25(2): 225-233.
22.	Wang Y, Zhang Y, Zhang X, et al. A single posterior approach for multilevel modified vertebral column resection in adults with severe rigid congenital kyphoscoliosis: a retrospective study of 13 cases. Eur Spine J, 2008, 17(3): 361-372.

1. Kandwal P, Vijayaraghavan GP, Nagaraja UB, et al. Severe rigid scoliosis: review of management strategies and role of spinal osteotomies. Asian Spine J, 2017, 11(3): 494-503.
2. Zhang Y, Hai Y, Tao L, et al. Posterior multiple-level asymmetrical ponte osteotomies for rigid adult idiopathic scoliosis. World Neurosurg, 2019, 127: e467-e473.
3. Mallepally AR, Mahajan R, Rustagi T, et al. Is VCR necessary to correct very severe deformity? Case report and review of literature. Int J Neurosci, 2020. [Epub ahead of print].
4. Lee BH, Hyun SJ, Han S, et al. Surgical and radiological outcomes after posterior vertebral column resection according to the surgeon’s experience. Medicine (Baltimore), 2018, 97(34): e11660.
5. 王号中, 修鹏, 汪雷, 等. 儿童及青少年脊柱畸形矫形围术期疼痛管理的研究进展. 中国修复重建外科杂志, 2019, 33(5): 644-649.
6. Mohamed Ali Hussien, Mohamed Abdulsalam Wafa, Ahmed mohamed Elbadrawi, et al. Posterior vertebral column resection for congenital rigid spinal deformities. Current Orthopaedic Practice, 2019, 30(4): 361-369.
7. Iyer S, Duah HO, Wulff I, et al. The use of halo gravity traction in the treatment of severe early onset spinal deformity. Spine (Phila Pa 1976), 2019, 44(14): E841-E845.
8. Shimizu T, Lenke LG, Cerpa M, et al. Preoperative halo-gravity traction for treatment of severe adult kyphosis and scoliosis. Spine Deform, 2020, 8(1): 85-95.
9. McIntosh AL, Brandon SR, Charles JC, et al. Halo gravity traction for severe pediatric spinal deformity: A clinical concepts review. Spine Deformity, 2019, 7(3): 395-403.
10. Davies NR, Vasquez Rodriguez V, Remondino RG, et al. Inpatient versus outpatient halo-gravity traction in children with severe spinal deformity. Spine Deform, 2020. [Epub ahead of print].
11. 王华锋, 刘辉, 郑召民, 等. 后路脊柱截骨术与牵引辅助后路广泛松解术治疗重度脊柱畸形的比较研究. 中国骨与关节杂志, 2014, 3(12): 896-900.
12. Koller H, Zenner J, Gajic V, et al. 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, 2012, 21(3): 514-529.
13. Lenke LG, Sides BA, Koester LA, et al. Vertebral column resection for the treatment of severe spinal deformity. Clin Orthop Relat Res, 2010, 468(3): 687-699.
14. Qiao J, Xiao L, Xu L, et al. Skull-femoral traction after posterior release for correction of adult severe scoliosis: efficacy and complications. BMC Musculoskelet Disord, 2018, 19(1): 277.
15. Xie JM, Zhang Y, Wang YS, et al. The risk factors of neurologic deficits of one-stage posterior vertebral column resection for patients with severe and rigid spinal deformities. Eur Spine J, 2014, 23(1): 149-156.
16. Takata Y, Lenke LG, Kelly MP. Posterior vertebral column resection for rigid proximal thoracic kyphoscoliosis with broken growing rods in a patient with Desbuquois dysplasia. Spine Deform, 2020, 8(1): 135-138.
17. Riley MS, Lenke LG, Chapman TM Jr, et al. Clinical and radiographic outcomes after posterior vertebral column resection for severe spinal deformity with five-year follow-up. J Bone Joint Surg (Am), 2018, 100(5): 396-405.
18. Yang C, Wang H, Zheng Z, et al. Halo-gravity traction in the treatment of severe spinal deformity: a systematic review and meta-analysis. Eur Spine J, 2017, 26(7): 1810-1816.
19. Bao H, Yan P, Bao M, et al. Halo-gravity traction combined with assisted ventilation: an effective pre-operative management for severe adult scoliosis complicated with respiratory dysfunction. Eur Spine J, 2016, 25(8): 2416-2422.
20. Smith JS, Sansur CA, Donaldson WF 3rd, et al. Short-term morbidity and mortality associated with correction of thoracolumbar fixed sagittal plane deformity: a report from the Scoliosis Research Society Morbidity and Mortality Committee. Spine (Phila Pa 1976), 2011, 36(12): 958-964.
21. Chang DG, Yang JH, Lee JH, et al. Congenital scoliosis treated with posterior vertebral column resection in patients younger than 18 years: longer than 10-year follow-up. J Neurosurg Spine, 2016, 25(2): 225-233.
22. Wang Y, Zhang Y, Zhang X, et al. A single posterior approach for multilevel modified vertebral column resection in adults with severe rigid congenital kyphoscoliosis: a retrospective study of 13 cases. Eur Spine J, 2008, 17(3): 361-372.

Chinese Journal of Reparative and Reconstructive Surgery

Comparison of radiological changes after Halo-pelvic traction with posterior spinal osteotomy versus simple posterior spinal osteotomy for severe rigid spinal deformity

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