%0 Journal Article %1 Takeshita2006 %A Takeshita, Katsushi %A Lenke, Lawrence G %A Bridwell, Keith H %A Kim, Yongjung J %A Sides, Brenda %A Hensley, Marsha %D 2006 %J Spine %K Adolescent; Adult; Bone Nails; Cerebral Palsy; Child; Female; Femur; Humans; Internal Fixators; Intraoperative Period; Male; Muscular Dystrophies; Neuromuscular Diseases; Pelv; Sacrum; Scoliosis; Spinal Fusion; Thoracic Vertebrae; Traction; Treatment Outcome; is %N 20 %P 2381--2385 %R 10.1097/01.brs.0000238964.73390.b6 %T Analysis of patients with nonambulatory neuromuscular scoliosis surgically treated to the pelvis with intraoperative halo-femoral traction. %U http://dx.doi.org/10.1097/01.brs.0000238964.73390.b6 %V 31 %X STUDY DESIGN: Retrospective case-control study. OBJECTIVES: To compare patients treated with and without intraoperative halo-femoral traction to assess neuromuscular spinal deformity correction as well as the safety of the technique. SUMMARY OF BACKGROUND DATA: Optimal sitting balance can be achieved in nonambulatory neuromuscular patients with pelvic obliquity by maneuvering a Galveston-type rod or inserting screws into the iliac wings; however, this is often clinically challenging because of the small, soft bone-stock in the pelvis of these patients. METHODS: A total of 40 patients with nonambulatory neuromuscular scoliosis were treated surgically with a T2 or T3-sacrum instrumented posterior spinal fusion. There were 20 patients (12 who underwent posterior spinal fusion-alone and 8 anterior/posterior spinal fusion) who had intraoperative halo-femoral traction performed unilaterally on the high side iliac wing compared to a control group of 20 patients (15 who underwent posterior spinal fusion-alone and 5 anterior/posterior spinal fusion) operatively treated without halo-femoral traction. Each group had 14 patients with spastic (cerebral palsy) scoliosis, and 6 with flaccid (muscular dystrophy) scoliosis deformities. Minimum follow-up for all patients was 2 years (range 3-12). RESULTS: Preoperative lumbar scoliosis averaged 87 degrees (range 30 degrees-141 degrees) in the halo-femoral traction group and 67 degrees (range 28 degrees-108 degrees) in the control group (P = 0.012). Postoperative lumbar Cobb decreased to 35 degrees (range 15 degrees-60 degrees) in the halo-femoral traction group and 32 degrees (range 4 degrees-66 degrees) in the control group (P = 0.181). Preoperative pelvic obliquity averaged 26 degrees (range 8 degrees-47 degrees) in the halo-femoral traction group and 17 degrees (range 8 degrees-44 degrees) in the control group (P = 0.017); postoperative averaged 6 degrees (range 1 degrees-23 degrees) in the halo-femoral traction group and 7 degrees (range 0 degrees-27 degrees) in the control group. Average pelvic obliquity correction was 78\% in the halo-femoral traction group and 52\% in the control group (P = 0.001). There were no intraoperative or postoperative halo-femoral traction apparatus-related complications noted (pin cut-out, femoral fractures, pin-sight infections, etc.). CONCLUSIONS: Intraoperative use of halo-femoral traction during the surgical treatment of patients with nonambulatory neuromuscular scoliosis provided significantly improved lumbar curve and pelvic obliquity correction. Intraoperative halo-femoral traction had no associated perioperative complications.

@article{Takeshita2006, abstract = {STUDY DESIGN: Retrospective case-control study. OBJECTIVES: To compare patients treated with and without intraoperative halo-femoral traction to assess neuromuscular spinal deformity correction as well as the safety of the technique. SUMMARY OF BACKGROUND DATA: Optimal sitting balance can be achieved in nonambulatory neuromuscular patients with pelvic obliquity by maneuvering a Galveston-type rod or inserting screws into the iliac wings; however, this is often clinically challenging because of the small, soft bone-stock in the pelvis of these patients. METHODS: A total of 40 patients with nonambulatory neuromuscular scoliosis were treated surgically with a T2 or T3-sacrum instrumented posterior spinal fusion. There were 20 patients (12 who underwent posterior spinal fusion-alone and 8 anterior/posterior spinal fusion) who had intraoperative halo-femoral traction performed unilaterally on the high side iliac wing compared to a control group of 20 patients (15 who underwent posterior spinal fusion-alone and 5 anterior/posterior spinal fusion) operatively treated without halo-femoral traction. Each group had 14 patients with spastic (cerebral palsy) scoliosis, and 6 with flaccid (muscular dystrophy) scoliosis deformities. Minimum follow-up for all patients was 2 years (range 3-12). RESULTS: Preoperative lumbar scoliosis averaged 87 degrees (range 30 degrees-141 degrees) in the halo-femoral traction group and 67 degrees (range 28 degrees-108 degrees) in the control group (P = 0.012). Postoperative lumbar Cobb decreased to 35 degrees (range 15 degrees-60 degrees) in the halo-femoral traction group and 32 degrees (range 4 degrees-66 degrees) in the control group (P = 0.181). Preoperative pelvic obliquity averaged 26 degrees (range 8 degrees-47 degrees) in the halo-femoral traction group and 17 degrees (range 8 degrees-44 degrees) in the control group (P = 0.017); postoperative averaged 6 degrees (range 1 degrees-23 degrees) in the halo-femoral traction group and 7 degrees (range 0 degrees-27 degrees) in the control group. Average pelvic obliquity correction was 78\% in the halo-femoral traction group and 52\% in the control group (P = 0.001). There were no intraoperative or postoperative halo-femoral traction apparatus-related complications noted (pin cut-out, femoral fractures, pin-sight infections, etc.). CONCLUSIONS: Intraoperative use of halo-femoral traction during the surgical treatment of patients with nonambulatory neuromuscular scoliosis provided significantly improved lumbar curve and pelvic obliquity correction. Intraoperative halo-femoral traction had no associated perioperative complications.}, added-at = {2014-07-19T21:42:10.000+0200}, author = {Takeshita, Katsushi and Lenke, Lawrence G and Bridwell, Keith H and Kim, Yongjung J and Sides, Brenda and Hensley, Marsha}, biburl = {https://www.bibsonomy.org/bibtex/244b84e5aadd88369653f453da3cf07fd/ar0berts}, doi = {10.1097/01.brs.0000238964.73390.b6}, groups = {public}, interhash = {47e35204d1a891ce741e82224efe651b}, intrahash = {44b84e5aadd88369653f453da3cf07fd}, journal = {Spine}, keywords = {Adolescent; Adult; Bone Nails; Cerebral Palsy; Child; Female; Femur; Humans; Internal Fixators; Intraoperative Period; Male; Muscular Dystrophies; Neuromuscular Diseases; Pelv; Sacrum; Scoliosis; Spinal Fusion; Thoracic Vertebrae; Traction; Treatment Outcome; is}, month = Sep, number = 20, pages = {2381--2385}, pii = {00007632-200609150-00020}, pmid = {16985468}, timestamp = {2014-07-19T21:42:10.000+0200}, title = {Analysis of patients with nonambulatory neuromuscular scoliosis surgically treated to the pelvis with intraoperative halo-femoral traction.}, url = {http://dx.doi.org/10.1097/01.brs.0000238964.73390.b6}, username = {ar0berts}, volume = 31, year = 2006 }