The effect of intraoperative traction during posterior spinal instrumentation and fusion for adolescent idiopathic scoliosis.
ABSTRACT A retrospective study comparing patients having traction and a control group not having traction during posterior spinal instrumentation and fusion (PSIF) for adolescent idiopathic scoliosis (AIS).
To evaluate the effect of intraoperative traction on surgical correction of AIS.
When the Cotrel-Dubousset instrumentation system was introduced, the use of intraoperative traction was advocated. However, there is no specific report documenting the effect of intraoperative traction on the correction of AIS.
The medical and radiologic records of 140 AIS patients treated by PSIF were reviewed. Forty of these patients had intraoperative traction using a head halter associated with lower extremity skin traction. The radiologic outcome was compared between the two groups intraoperatively (before instrumentation with the first rod) and after surgery using Student t tests (level of significance = 0.05).
The intraoperative and postoperative corrections of the coronal primary Cobb angle were similar for both groups, although the patients in the traction group had smaller preoperative Cobb angles and more flexible curves and were instrumented with more screws. The postoperative thoracic kyphosis was significantly increased in both groups. The lumbar lordosis at the 1-year follow-up was maintained in the control group, but it was significantly decreased in the traction group.
The authors do not recommend the routine use of intraoperative traction using a head halter combined with skin traction for all AIS patients undergoing PSIF. However, it could be helpful in selected cases, such as in patients having pelvic obliquity and requiring instrumentation of the pelvis.
[show abstract] [hide abstract]
ABSTRACT: A numerical study was conducted by simulating the Cotrel-Dubousset (CD) surgery. To quantify intraoperative correction during CD surgery. Very few methods have been reported in literature to analyze the effect of intraoperative surgical gestures, and none considers the three-dimensional correction of the entire spine during the main surgical gestures. Intraoperative frontal radiographs limit analysis to two-dimensional correction, and movement tracking devices focus the kinematics study of specific vertebrae in the instrumented area only. This study included 20 patients, mean age 15 years, with severe idiopathic scoliosis treated by CD surgery. A patient-specific finite-element model (T1-L5 and pelvis), based on preoperative stereo-radiography and flexibility test radiographs, was constructed for each patient. An automated algorithm simulated all the main steps of the CD surgery. For each step, vertebral kinematics was exported to compute the evolution of various clinical parameters. Coherence of the simulations was evaluated by comparing the virtual postoperative spinal configuration with postoperative in vivo data. The CD surgery affected the vertebral levels inside but also outside the fused spinal area, in a three-dimensional complex kinematics. Every intraoperative maneuver contributes to scoliosis correction. The second rod insertion, focused on the apical vertebra, leading to a global modification of all the curves. The automated patient-specific simulation of CD surgery may improve our understanding of surgical biomechanics. Therefore, it could increase the relevance of preoperative surgery planning.Spine 04/2009; 34(5):512-9. · 2.08 Impact Factor