Analysis of Non-Ambulatory Neuromuscular Scoliosis Patients Surgically Treated to the Pelvis with Intraoperative Halo-Femoral Traction

Summary: 40 non-ambulatory neuromuscular scoliosis patients treated with a T2-sacrum instrumented fusion were reviewed with 20 having intraoperative halo-femoral traction and 20 controls without. Averaged correction of pelvic obliquity was 79% in the halo-femoral group compared to 57% in the control group (p=0.015). Thus, intraoperative use of halo-femoral traction in these patients afforded both improved lumbar curve correction and pelvic obliquity correction without any associated complications.

Purpose: To compare patients treated with and without intraoperative halo-femoral traction (H-F TX) to assess correction of neuromuscular (NM) spinal deformity.

Methods: 40 patients with non-ambulatory NM scoliosis were treated with a T2-sacrum instrumented posterior spinal fusion (PSF). 20 patients (12 PSF-alone, 8 AFS/PSF) having intraoperative H-F Tx performed unilaterally on the high side iliac wing were compared to a control group of 20 (15 PSF-alone, 5 ASF/PSF) patients treated similarly except without H-F Tx. Each group had 14 patients with spastic scoliosis, and 6 patients with flaccid deformities and minimum 2-year follow-up for all patients (range 3- 12 years). Patients were positioned prone with an average of 25lbs (range 15-40) placed on the femoral traction pin until pelvic obliquity was corrected.

Results: Lumbar scoliosis averaged 87º (range 30-141º) in the H-F Tx group and 67º (range 32-108º) in the control group (p=0.012). Postoperatively, the lumbar Cobb in the H-F Tx group decreased to 35º (range 11-37º) as compared to 32º (range 4-72º) in the control group (p=0.181). Pelvic obliquity averaged 26º (range 8-47º) in the H-F Tx group, and 17º (range 4-49º) in the control group preop (p=0.017), and postop decreased to 6º (range 1-23º) in the H-F Tx group, while the control group averaged 7º (range 0-27º). Average correction of pelvic obliquity was 79% in the H-F Tx group compared to 57% in the control group (p=0.001). There were no intraoperative or postoperative complications related to the use of the H-F Tx apparatus. Eliminating patients who had an ASF procedure produced similar correction results superior for the H-F Tx group for lumbar scoliosis (p=0.012) and pelvic obliquity (p<0 .0001) correction.

Conclusions: Intraoperative use of halo-femoral traction in non-ambulatory NM scoliosis patients provided significantly improved lumbar scoliosis and pelvic obliquity correction, without any perioperative complications.