Comparison of effectiveness of Halo-femoral traction after anterior spinal release in severe idiopathic and congenital scoliosis: a retrospective study

Abstract

Background: Halo-femoral traction could gradually improve the coronal and sagittal deformity and restore the trunk balance through the elongation of the spine. The purpose of this retrospective study was to assess the effectiveness of Halo-femoral traction after anterior spinal release in the management of severe idiopathic and congenital scoliosis.

Methods: Sixty patients with severe and rigid curve treated with anterior spinal release, Halo-femoral traction, and second stage posterior spinal fusion were recruited for this retrospective study. Idiopathic Scoliosis (IS) group was 30 patients (23 females and 7 males) with mean age of 15.5 years. The average coronal Cobb angle was 91.6 degrees and the mean global thoracic kyphosis was 50.6 degrees . The curve type of these patients were 2 with Lenke 1AN, 4 with Lenke 1A+, 1 with Lenke 1BN, 10 with Lenke 1CN, 3 with Lenke 1C+, 3 with Lenke 3CN, 3 with Lenke 3C+, and 4 with Lenke 5C+. Congenital Scoliosis (CS) group included 30 patients (20 females and 10 males) with average age of 15.2 years. The average coronal Cobb angle of the main curve before operation was 95.7 degrees and the average thoracic kyphosis was 70.2 degrees . All patients had a minimum 12-month follow-up radiograph (range 12-72 months, mean 38 months).

Results: The average traction time was 23 days and the average traction weight was 16 kg. Four patients experienced brachial plexus palsy and complete nerve functional restoration was achieved at two months follow-up. For the IS group, the post-operative mean Cobb angle of major curve averaged 40.1 degrees with correction rate of 57.5%. For the CS group, the post-operative mean Cobb angle was 56.5 degrees with average correction rate of 45.2%. The difference in curve magnitude between the IS and CS patients after posterior correction was statistically significant (t = 4.15, p < 0.001). The correction rate of kyphosis between IS and CS patients was also statistically significant (t = -2.59, p < 0.016).

Conclusion: Halo-femoral traction was a safe, well-tolerated and effective method for the treatment of severe and rigid scoliosis patients. The posterior correction rate obtained after anterior release and traction was significant superior than that recorded from side bending film in current study.

Figure 1

A 14-year-old girl with idiopathic scoliosis and the Lenke classification was 1C+. A-B: AP radiographs before treatment showing right thoracic scoliosis measured 92°. C:Bending films showed right thoracic scoliosis corrected to 77°. D:The right thoracic curve correction obtained with Halo-femoral traction treatment was 40.2%. E-F:The major curve measured 35° after posterior spinal fusion and the correction rate was 62%. G-H: AP and lateral radiographs at 20-month follow-up showed solid spinal fusion with a 37° right thoracic curve.

Figure 2

A 13-year-old girl with congenital scoliosis with defect of formation and segmentation. A-B: AP radiographs before treatment showed left thoracic scoliosis measured 98° and thoracic kyphosis measured 85°. C:Bending films showed right thoracic scoliosis only corrected to 90°. D:The left thoracic curve correction obtained with Halo-femoral traction was 24.1%. E-F:The major curve measured 50°after posterior spinal fusion with correction rate of 49.0%. The correction rate of kyphosis was 47.1%. G-H: AP and lateral radiographs at 18-month follow-up showed solid spinal fusion with a 53°left thoracic curve and a 45° thoracic kyphosis.