Skull-femoral traction after posterior release for correction of adult severe scoliosis: efficacy and complications.

Abstract

BACKGROUND:

It is a great challenge for spine surgeons to correct severe rigid scoliosis. We developed a three- staged correction (one stage posterior release and screw placement, two stage skull-femoral traction and three stage posterior instrumentation) for adult severe scoliosis. The objective of this study is to investigate safety and efficacy of a three- staged correction for adult severe scoliosis.

METHODS:

A retrospective review was performed for patients with severe scoliosis receiving three- staged correction (one stage posterior release and screw placement, two stage skull-femoral traction and three stage posterior instrumentation) from June 2001 to October 2014. The inclusion criteria were as follows: [1] age more than 18 years; [2] main curve larger than 90°; [3] a minimum 2-year follow-up. Patients were excluded if they had a history of surgery or anterior release or receiving three column osteotomies.

RESULTS:

A total of 63 patients were included (37 female and 26 male), with a mean age of 22.7 years (range: 18-30 years) and follow-up of 42.6 months (range: 24-108 months). The aetiology was congenital in 27 patients, neuromuscular in 18, idiopathic in 11, neurofibromatosis-1 in 4 and Marfan syndrome in 3. The mean traction weight was 28.4 kg (range: 18-32 kg), equal to 57.2% of patients' body weight (range: 42.7-72.3%). The mean traction time was 22.7 days (range: 12-44 days). Postoperative correction rate was 55% (range: 38-78%) for scoliosis and 51% (range: 32-75%) for kyphosis. Contribution of traction to correction was 51% (range: 36-70%) for scoliosis and was 43% (range: 34-55%) for kyphosis.

CONCLUSIONS:

Three- staged correction (one stage posterior release and screw placement, two stage skull-femoral traction and three stage posterior instrumentation) could effectively correct adult severe scoliosis. The incidence of complications of skull-femoral traction was not low, but transient and could be successfully managed.

• Authors: Jun Qiao, Lingyan Xiao, Leilei Xu, Zhen Liu, Xu Sun, Bangping Qian, Zezhang Zhu, Yong Qiu
• Journal: BMC musculoskeletal disorders (BMC Musculoskelet Disord) Vol. 19 Issue 1 Pg. 277 (Aug 02 2018) ISSN: 1471-2474 [Electronic] England
• PMID: 30068340 (Publication Type: Journal Article)

Topics

• Adolescent
• Adult
• Biomechanical Phenomena
• Bone Screws
• Female
• Humans
• Male
• Osteotomy
• Recovery of Function
• Retrospective Studies
• Scoliosis (diagnostic imaging, physiopathology, surgery)
• Severity of Illness Index
• Spinal Fusion (adverse effects, instrumentation, methods)
• Spine (diagnostic imaging, physiopathology, surgery)
• Time Factors
• Traction (adverse effects, methods)
• Treatment Outcome
• Young Adult