Intraoperative halo-femoral traction during posterior spinal arthrodesis for adolescent idiopathic scoliosis curves between 70° and 100°: a randomized controlled trial

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  • 1 Department of Orthopedics, and
  • | 2 Health Management Center, Changzheng Hospital, Naval Medical University, Shanghai; and
  • | 3 Department of Orthopedics, the 72nd Army Hospital of PLA, Huzhou, Zhejiang, People’s Republic of China
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OBJECTIVE

Surgical management of scoliosis curves between 70° and 100° remains controversial. The authors designed this randomized controlled trial to validate the efficacy of intraoperative halo-femoral traction (IOHFT) in patients with adolescent idiopathic scoliosis (AIS), Cobb angles between 70° and 100°, and flexibility < 35%.

METHODS

The authors prospectively recruited and randomized 29 patients with severe AIS scheduled for posterior surgery into a traction group or control (nontraction) group. The primary outcome measures were operative time, blood loss, and length of hospital stay. Secondary outcomes included degree of spine deformity correction, traction-related complications, and health-related quality of life.

RESULTS

In the traction group, the average preoperative Cobb angle was 83.2°, with an average 20.6% flexibility. The average postoperative Cobb angle was 16.1° and the major curve was 18.3° at the final follow-up. In the control group, the average preoperative major curve was 80.3° with 22.8% flexibility. The average postoperative Cobb angle was 16.1° and the major curve was 18.1° at the final follow-up. The operative duration was 325.7 minutes for the traction group and 385.4 minutes for the control group (p = 0.018). Compared with the control group, the traction group had a 29.5% reduction in intraoperative blood loss and a significantly lower rate of blood transfusion (13.3% vs 50.0%, p = 0.033). There were no neurological complications in either group. One patient in the traction group had a superficial infection at the traction site.

CONCLUSIONS

Use of IOHFT contributed to significant reductions in operative time and blood transfusion requirements, with no added morbidity. It is an effective and safe method to assist correction of AIS curves between 70° and 100° and flexibility < 35%.

ABBREVIATIONS

AIS = adolescent idiopathic scoliosis; ASA = American Society of Anesthesiologists; IOHFT = intraoperative halo-femoral traction; IONM = intraoperative neuromonitoring; LL = lumbar lordosis; MEP = motor evoked potential; PA = posteroanterior; PCA = patient-controlled anesthesia; PI = pelvic incidence; PT = pelvic tilt; SRS-22 = Scoliosis Research Society-22 questionnaire; SS = sacral slope; SSEP = somatosensory evoked potential; SVA = sagittal vertebral axis; TK = thoracic kyphosis; VAS = visual analog scale.

Illustrations from Hubbe et al. (pp 160–163). Copyright Ioannis Vasilikos and Roberto Ferrarese. Published with permission.

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