| Objective: The purpose of this retrospective study was to assess the effectiveness of Halo-pelvic traction in the management of severe and rigid Scoliosis,Kyphosis and Kyphoscoliosis.Materials and methods: To investigate the use of HPT in severe deformities,we performed a retrospective review of 21 patients(age range,11-19 y,average 14.4 y)had severe and rigid scoliosis,kyphosis or kyphoscoliosis who treated with HPT,and second stage posterior spinal fusion at the same spine centre in tertiary-care hospital between February 2002 and March 2016.The mean preoperative coronal Cobb angel was 81.4°±34.3°,and the mean sagittal Cobb angel was 65.4°±26.1°.There were eight Idiopathic Scoliosis,one Congenital Malformation,five Tuberculosis Kyphosis,three Neuromuscular Scoliosis,three Scoliosis in Neuro-fibromatosis,one Ehlers-Danlos Syndrome.Inclusion criteria were preoperative HPT(before anterior and/or posterior spinal fusion),pretraction spinal Radiographs and pulmonary function tests(PFTs),repeat Radiographs and PFTs taken at the completion of traction and final Radiographs and PFTs after 3 months surgical correction.Patients in traction(maximum traction length range 6 cm to 16 cm,average 10.3 cm)for a duration of at least 4 weeks(range 26-43 d,average 33d)were included.The analysis focused on the impact of HPT on Curve Flexibility,Height,Cobb Angel,Pulmonary Functions,Durations,Complications and Surgical Outcomes.All patients had a minimum 12-month follow-up data(range 12–72 months,mean 38 months).Results: The average traction time was 33 d and the average traction length was 10.3 cm.For the Scoliosis,the post-traction mean coronal Cobb angle of major curve averaged 32.1°±15.4°,change 49.3°±21.2° with correction rate of 60.6%,differences reach statistical significance(P<0.000).For the Kyphosis,the post-traction mean sagittal Cobb angle was 32.3°±11.2°,change33.1°±18.0° with average correction rate of 50.4%,differences reach statisticalsignificance(P<0.000).Pre-traction,pre-operative,post-operative and 3,6,9,12 month follow-up PFT data were obtained for all the patients.The mean pre-tracion FVC% in these patients was 50.4%±11.8%(30.8-68.8%,n=21),and the post traction FVC% was82.1%±11.7%(65.3-108.2%,n=21),change 31.7±10.3(8.2-52.1%,n=21),differences reach statistical significance(P=0.003).Conclusion: preoperative Halo-pelvic traction was a safe,well-tolerated and effective method for the treatment of severe and rigid spine deformities,while avoiding many serious complications from a rapid,one-stage correction.Respiratory function improved after HPT. |
