Halo-pelvic traction for severe kyphotic deformity secondary to spinal tuberculosis

Abstract

To evaluate the efficacy and safety of Halo-pelvic ring traction in the treatment of severe kyphotic deformity secondary to spinal tuberculosis.Eighty patients with severe kyphotic deformity due to spinal tuberculosis were included in the study. Forty of those patients (experimental group) received Halo- pelvic ring traction before surgery and the rest (control group) received surgical treatment directly. Two groups were compared by means of the duration of surgery, intraoperative blood loss, correction of Cobb angle, change in patient height, and American Spinal Injury Association (ASIA) impairment scale.Halo-pelvic traction group achieved significantly (P < .05) better results than direct surgical treatment group by means of the time of surgery (244 ± 58 minutes vs 276 ± 47 minutes, P = .036), intraoperative blood loss (950 ± 236 mL 1150 ± 305 mL, P = .018), correction of Cobb angle (68.3 ± 12.6 vs 55.6 ± 13.8, P = .001), change in patient height (9.4 ± 4.0 cm vs 6.8 ± 3.8 cm, P = .024). The mean improvement of ASIA scale was more in the experimental group than in the control group (0.23 ± 0.07 vs 0.15 ± 0.06); however, the difference is not statistically significant (P = .09).Halo-pelvic ring traction before osteotomy can be applied in patients with severe spinal kyphotic deformity due to spinal tuberculosis to increase efficacy and safety of surgical treatment.

Figure 1

Pins in the cranial bone were placed with the same method as a halo ring (A). Two pins on the pelvic ring were inserted in the iliac crest and 2 in the posterior superior iliac spine (B). The correcting rods were used to connect the halo and pelvic rings, and were adjusted 3 to 5 mm a day to distract the spine between the 2 rings (C).

Figure 2

Patient 1: 30-year-old female, found a bump on her back 5 years ago, along with symptoms such as back pain, low fever, and sweat. X ray showed tuberculosis of T11, T12 levels with the Cobb angle of 96° (A). No paraspinal abscess was found, erythrocyte sedimentation rate was normal and the bone around the deficit was of fine quality. After 33 days of halo-pelvic fixation (B), the patient received spinal osteotomy under regional anesthesia. After the surgery, the Cobb angle was 15° (C).