Halo femoral traction and sliding rods in the treatment of a neurologically compromised congenital scoliosis: technique.
In severe congenital scoliosis, traction (whether with a halo or instrumental) is known to expose patients to neurologic complications. However, patients with restrictive lung disease may benefit from halo traction during the course of the surgical treatment. The goal of treatment of such deformities is, therefore, twofold: improvement of the respiratory function and avoidance of any neurologic complications. We report our technique to treat a 17-year-old girl with a multi-operated congenital scoliosis of 145 degrees and cor pulmonale. Pre-operative halo gravity traction improved her vital capacity from 560 c.c. to 700 c.c., but led to mild neurologic symptoms (clonus in the legs). To avoid further neurologic compromise, her first surgery consisted of posterior osteotomies and the implantation of two sliding rods connected to loose dominoes without any attempt at correction. Correction was then achieved over a 3-week period with a halofemoral traction. This allowed the two rods to slide while the neurologic status of the patient was monitored. Her definitive surgery consisted of locking the dominoes and the application of a contralateral rod. Satisfactory outcome was achieved for both correction of the deformity (without neurologic sequels) and improvement of her pulmonary function (1200 c.c. at 2 years). This technique using sliding rods in combination with halofemoral traction can be useful in high-risk, very severe congenital scoliosis.
Arlet
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Division of Orthopedic Surgery, McGill University, Montreal, Quebec, Canada.
Papin
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Marchesi
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D000293:Adolescent; D001858:Bone Nails; D001915:Braces / Q000009:adverse effects*; D005260:Female; D005269:Femur; D006801:Humans; D009422:Nervous System Diseases / Q000209:etiology*; D010027:Osteotomy; D011660:Pulmonary Heart Disease / Q000150:complications / Q000628:therapy; D011859:Radiography; D012600:Scoliosis / Q000150:complications / Q000151:congenital / Q000000981:diagnostic imaging / Q000628:therapy*; D014143:Traction / Q000009:adverse effects* / Q000379:methods