Comparison of the clinical outcome for adult idiopathic scoliosis treated by posterior spinal instrumentation with or without Halo-femoral traction after anterior release

English Keywords:Adult idiopathic scoliosis  Anterior spinal release  Halo-femoral traction  Posterior instrumentation

English Abstract:

  【Abstract】 Objectives： To compare the clinical outcome of posterior spinal instrumentation with or without Halo-femoral traction after anterior spinal release in the treatment of adult idiopathic scoliosis. Methods： 30 adult idiopathic scoliosis patients with Cobb angle range from 65°-90° treated from January 2003 to December 2007 were recruited into this retrospective study. The mean age of these patients was 23.4 years ranging 20-30 years. All patients received first operation without nerve injury before operation. Group A including 14 patients were treated by posterior instrumentation. Group B including 16 patients were treated by posterior instrumentation with Halo-femoral traction associated with anterior spinal release. The preoperative Cobb angle, age, sex ratio and curve pattern were similar in both groups. The mean follow-up was 40 months range from 12-72 months. Patients of two groups were compared with surgical time, blood loss, hospital stay time, complication, post-operative correction rate and coronal trunk balance. Results: The average surgical time (9.9±1.4h vs 6.7±1.2h) and length of hospital stay(41±10d vs 24±18d) in group B were much longer than that in group A(P<0.05). There was no complication occurred in the both groups at the final follow-up. The post-operative correction rate of group B was higher than that of group A［(64.5±11.6)％ vs (51.3±11.8)％, P<0.05]. Both groups achieved the similar postoperative thoracic sagittal alignment(20.6°±8.4° vs 20.4°±6.7°, P>0.05) and coronal trunk balance(1.32±0.65cm vs 1.30±0.70cm, P>0.05). There was no difference in terms of the loss of correction rate between the two groups at the final follow-up［(3.5±2.4)％ vs (2.8±1.5)％, P>0.05]. Conclusions: Halo-femoral traction associated with anterior spinal release is a safe and effective method to increase the correction rate in the moderate severe scoliosis patients with the Cobb angle ranging from 65 to 90 degrees, but may not be necessary because of the increased surgical time and hospital stay.