The effect of preoperative traction on the complication of nerve injury in severe spinal deformity correction surgery

English Keywords:Severe spinal deformities  Traction surgery  Corrective surgery  Neurological injury

English Abstract:

  【Abstract】 Objectives: To explore the effect of preoperative traction on nerve injury complications in patients with severe spinal deformities undergoing correction surgery. Methods: A retrospective analysis was conducted on 196 patients with severe spinal deformities who underwent orthopedic surgery in our hospital from December 2019 to December 2022. A total of 38 patients with severe stiff spinal deformity were treated with Halo-pelvic traction(HPT) before operation, including 17 males and 21 females, aged 20.12±7.82 years old(14 to 30 years), who were included into the HPT group. The other 158 patients with general severe spinal deformity undergone skin traction(ST) with occipital jaw and lower limb traction before operation were included into ST group, which included 61 males and 97 females, aged 15.55±10.38 years old(10-30 years). Posterior correction, fixation and fusion were performed after traction on both groups of patients. The general data, operation-related data, and imaging data before and after treatment(before traction, after traction, and after oepration) were collected, and the contribution rates of preoperative traction and operation to deformity correction were calculated. The abnormal conditions of intraoperative neurophysiological monitoring(IONM) and postoperative nerve injury complications were collected and compared between the two groups. Results: The preoperative Cobb angle of the HPT group was 142.48°±18.77°, which improved to 72.56°±13.26° after HPT, with an improvement rate of 49.07%; After corrective surgery, it was 55.76°±15.87°, with an improvement rate of 60.87%; 5 cases were of >Ⅳ grade osteotomy, accounting for 13.16%; There were 10 cases with abnormal IONM, accounting for 26.32%; And 3 cases of nerve damage, accounting for 7.90%. The preoperative Cobb angle of the patients in the ST group was 97.90°±19.25°, which was 76.51°±12.68° after traction, with an improvement rate of 21.85%; After corrective surgery, it was 41.58°±15.84°, with an improvement rate of 57.53%; 10 cases were of >Ⅳ grade osteotomy, accounting for 6.33%; There were 21 cases with abnormal IONM, accounting for 13.29%; And 9 cases of nerve injury, accounting for 5.70%. There was no significant difference in high-grade spinal osteotomy between the two groups(P>0.05). The difference in the incidence of abnormal IONM between the two groups was significant(P<0.05), however, there was no significant difference in the incidence of postoperative nerve injury complications(P>0.05). Conclusions: The applications of HPT and ST occipital jaw-lower limb traction before orthopedic surgery are both effective and safe in patients with spinal deformity, which can reduce the level of spinal osteotomy and reducing the risk of nerve injury complications in severe spinal deformity patients undergoing correction surgery.