ABSTRACT
Objective: To determine the effectiveness of peri-operative halo-femoral traction in the management of severe scoliosis and kyphoscoliosis - A retrospective review.
Methods: The case notes for 94 subjects with severe scoliosis and kyphoscoliosis were studied from 1973 to 2012 from Princess Elizabeth Centre Trinidad, West Indies. The notes studied were based on hospital records, standing pre-operative antero-posterior (AP) radiographs, post traction radiographs, immediate post operative AP x-rays and one year follow up x-rays. The primary outcome measure was coronal curve correction (Cobb’s angle) immediately post operatively after patients received halo-femoral traction. Other endpoints were intra-operative time and blood loss, coronal curve at one year and postoperative complication rates. All statistical analyses were conducted using SPSS Inc. statistics for windows version 17.0 Chicago SPSS Inc.
Results: Subjects were analyzed by age at date of surgery ( range 11- 37 years, mean 17 years), gender ( 80.9% females, 19.1% males), major coronal curve magnitude ( range 60 – 130 ⁰, mean 87⁰ ), duration of traction (range 6 – 21 days, mean 12 days), types of instrumentation, intra-operative time (range 1.34 – 8.75 hours, mean 3.67 hours), intra-operative blood loss ( range 263 – 3259 ml, mean 1190 ml), coronal curve correction post operatively (range 20- 100⁰, mean 47⁰) and at 1 year follow up (range 25– 80 ⁰, mean 52⁰ ). The commonest post operative complication was hardware migration (8.5 %).
Conclusion: The management of severe scoliosis continues to be difficult due to its multi-planar presentation. A useful adjunct to the spinal surgeon’s arsenal against major curves is halo-femoral traction. When combined with spinal instrumentation and fusion, this treatment protocol is proven to be safe, tolerable and effective in our local setting.
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