Preoperative Halo-gravity traction in the treatment of severe pediatric scoliosis and kyphosis

English Keywords:Scoliosis  Kyphosis  Traction  Surgery  Correction

English Abstract:

  【Abstract】 Objective：To evaluate the efficacy of preoperative Halo-gravity traction in the treatment of severe pediatric scoliosis and kyphosis.Method：17 patients with severe scoliosis and kyphosis received Halo-gravity traction prior to posterior spine fusion were studied retrospectively.There were 8 males and 9 females，with a mean age of 6.8 years（range，4-8 years）.The Cobb angle of coronal major curve and the thoracic kyphosis（T5-T12） were 116.4° and 90.2° respectively.All patients underwent preoperative Halo-gravity traction，and after the maximum weight traction for 4-15 weeks，a posterior instrumentation and fusion was performed.The correction rate of coronal major curve under supine position and that after Halo-gravity traction and after surgery was compared.Result：The maximum traction weight averaged 9kg.All patients were followed up for at least 18-month.One patient experienced transient brachial plexus palsy which resolved completely by decreasing the traction weight.No neurologic complication，death and respiratory failure occurred after surgery. Compared with the correction rate of 15.4％ in supine position，the correction rate of coronal major curve after Halo-gravity traction increased 23%（P<0.05）.The postoperative correction rate of coronal major curve and thoracic kyphosis were 48.3% and 38.8% respectively.At final follow-up，the loss of coronal and sagittal correction averaged 2.3% and 2.9% respectively.The pulmonary function and blood gas test improved significantly after Halo traction.Conclusion：Preoperative Halo-gravity traction followed by posterior instrumentation is effective for pediatric severe scoliosis and kyphosis due to improved flexibility and pulmonary function.However，the traction related complications should not be ignored.