Temporary Internal (Dis)Traction as an Aid to Correction Of Severe Scoliosis

Methods: Ten patients from two institutions with severe spinal curvature greater than 90 degrees were considered candidates for traction prior to their definitive correction. One patient had diastrophic dysplasia, four had cerebral palsy, one had myelomeningocele with Chiari, one had syndromic scoliosis and three had severe idiopathic scoliosis. Three had absolute contra-indications to halo traction: fixed cervical kyphosis, cervical instability or deformity. Five had relative contraindications: distal deformity, movement disorders or hip flexion contractures. Mean curve size preoperatively was 105 degrees. These patients underwent an initial posterior release of the rigid portion of the spine (five also anterior) and placement of a longitudinal internal distraction rod. Initial distraction intra-operatively was followed in seven cases by 1-2 additional interval distractions. Finally, posterior spinal fusion with definitive dual-rod fixation was performed. Minimum 2 year follow-up of all patients.

Results: Internal distraction produced improvement at each distraction. This facilitated safe, gradual soft tissues and skeletal deformity. Mean initial correction was 52%, at insertion of first distraction rod. This compares favorably with 30-41% reported in the literature after halo traction. Mean time between initial and final procedure was 3 weeks. Mean final curve correction was 76%. There were no neurologic deficits or infections.

Conclusions: Temporary internal (dis)traction is an alternative to halo-based traction. It may be preferred for patients who have contraindications to halo traction such as cervical deformity or instability, or connective tissue laxity. It is also more effective for curves in the caudal end of the spine. It eliminates long hospital stays and enhances longer staging between procedures. It may be beneficial for some curve types considered for halo traction.