The effect of intraoperative traction during posterior spinal instrumentation and fusion for adolescent idiopathic scoliosis.
METHODS
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).


OBJECTIVE
To evaluate the effect of intraoperative traction on surgical correction of AIS.


BACKGROUND
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.


METHODS
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).


RESULTS
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.


CONCLUSIONS
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.
Mac-Thiong
Jean-Marc
JM
Department of Surgery, Université de Montréal, Montreal, Quebec, Canada.
Labelle
Hubert
H
Poitras
Benoit
B
Rivard
Charles-Hilaire
CH
Joncas
Julie
J
D000293:Adolescent; D016063:Blood Loss, Surgical; D005260:Female; D006801:Humans; D016268:Internal Fixators; D007430:Intraoperative Care / Q000379:methods*; D007432:Intraoperative Period; D008297:Male; D011859:Radiography; D012189:Retrospective Studies; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000601:surgery* / Q000628:therapy; D013123:Spinal Fusion / Q000295:instrumentation; D014143:Traction; D016896:Treatment Outcome