Safety and efficacy of osteotomy after halo pelvic traction in severe scoliosis accompanied with split cord malformation

English Keywords:Severe scoliosis  Halo pelvic traction  Osteotomy  Split cord malformation  Curative effect

English Abstract:

  【Abstract】 Objectives: To investigate the safety and clinical efficacy of osteotomy after halo pelvic traction for the treatment of severe scoliosis accompanied with split cord malformation. Methods: The data of eight cases of severe scoliosis with split cord malformation treated in our hospital from August 2012 to August 2019 were collected and retrospectively analyzed. None of them underwent resection of the longitudinal fissure. The follow-up period was 12-36 months. The traction time, height, weight, coronal Cobb angle, and sagittal Cobb angle were measured before and after traction, after orthopedic surgery, and at the final follow-up. Before and after traction, and after orthopedic surgery, vital capacity(VC), forced vital capacity(FVC), forced expiratory volume in one second(FEV1), FEV1/FVC(%), PO2, PCO2, triceps skin fold thickness, albumin concentration, and transferrin concentration were analyzed. Results: The traction time of 8 patients ranged from 22 days to 49 days(32.13±7.66 days). The height was 143-165cm(155.13±6.28cm) before traction and 156-175cm(167.88±4.66cm) after traction, increased by 12.75±2.11cm. There was no significant change in height after operation and at the last follow-up. The body weight was 47.20±4.55kg before traction, 48.84±4.19kg after traction, increased by 1.92±032kg, 49.21±4.22kg after orthopedic surgery, and 50.32±5.36kg at the last follow-up. The Cobb angle of the main curve was 92° to 176°(119.50°±15.13°) before traction, and 46° to 66°(54.88°±5.88°) after traction, with a correction rate of 39%-68%[(53.55±7.76)%]. It was 43°-66° (51.34°±7.47°) after orthopedic surgery, and the correction rate was 40%-72%[(58.54±8.87)%]. The correction angle was not lost at the last follow-up. The Cobb angle of sagittal plane was 62° to 132°(91.13°±10.23°) before traction and 29° to 51°(40.48°±6.32°) after traction, with a correction rate of 46%-71%[(51.17±12.14)%]. The correction rate was 47%-72%[(52.55±12.69)%] after orthopedic surgery. The correction angle was not lost at the last follow-up. VC was 3.75±0.26L before traction and 4.20±0.04L after traction. The improvement rate was (12.85±7.72)% and 4.22±0.05L after orthopedic surgery. FVC was 3.65±0.26L before traction and 4.14±0.04L after traction. The improvement rate was (14.21±8.30)% and 4.16±0.04L after orthopedic surgery. FEV1 was 3.34±0.22L before traction and 3.54±0.15L after traction. The improvement rate was (6.44±2.78)% and 3.54±0.15L after orthopedic surgery. FEV1/FVC, PO2 and PCO2 returned to normal range after traction and orthopedic surgery. The thickness of triceps skin fold, albumin and transferrin were improved by (11.55±4.60)%, (21.96±7.75)% and (23.13±8.51)%, compare with that before traction. Also, the thickness of triceps skin fold was improved by (14.12±4.97)%, albumin concentration was (23.12±7.87)%, and transferrin concentration was (25.43±8.18)%. All patients had no irreversible neurological dysfunction during and after the operation, and there were no complications such as loosening of nail track and infection during traction. At the last follow-up, no internal fixation displacement, loosening and fracture occurred. Conclusions: Halo pelvic traction is a safe and effective treatment for severe scoliosis accompanied with split cord malformation. It can avoid the higher risk of ridge resection, and can be considered as one of the first choice.