Brachial plexus palsy caused by halo traction before posterior correction in patients with severe scoliosis.
OBJECTIVE
To explore the clinical features and treatment results of brachial plexus palsy caused by halo traction before posterior correction in patients with severe scoliosis.


METHODS
A total of 300 cases of severe scoliosis received halo traction before posterior correction in our department from July 1997 to November 2004. Among them, 7 cases were complicated with brachial plexus palsy. The average Cobb angle was 110 degree (range, 90 degree-135 degree). Diagnoses were made as idiopathic scoliosis in 1 case, congenital scoliosis in 3 cases, and neuromuscular scoliosis in 3 cases. Additionally, diastematomyelia and tethered cord syndrome were found in 3 cases and thoracolumbar kyphosis in 2 cases. Weight of traction was immediately reduced when the patient developed any abnormal neurological symptoms in the upper extremity, and rehabilitation training was undertaken. Simultaneously, neurotrophic pharmacotherapy was applied, and the neurological function restoration of the upper limbs and the recovery time were documented.


RESULTS
Traction was used for an average of 3.5 weeks (range, 2-6 weeks) before spinal fusion for these 7 patients. The average traction weight was 8 kg, which was 19% on average (range, 13%-26%) of the average body weight (40.2 kg). These 7 patients had long and thin body configuration with a mean height of 175 cm. The duration between symptoms of brachial plexus paralysis and the diagnosis was 1-3 hours. All of these 7 patients presented various degrees of numbness in the ulnar side of the hand and forearm. Median nerve paresis was found in 3 cases and ulnar nerve paresis in 4 cases. Complete recovery of the neurological function had been achieved by the end of three months.


CONCLUSIONS
The clinical features of brachial plexus palsy caused by halo traction include median nerve paresis, ulnar nerve paralysis, and numbness in the ulnar side of the hand and forearm, which may be due to the injury of the inferior part of the brachial plexus, i.e., damage of C8 and T1 nerve roots. Complete recovery of neurological function can be expected when the patient is kept under careful observation for recognizing this complication as soon as possible, then immediately reducing or removing the traction weight, and adopting rehabilitation training and neurotrophic pharmaceutical treatment.
Bang-ping
Qian
Q
Department of Spine Surgery, Drum Tower Hospital, Medical School, Nanjing University, Nanjing 210008, China. qianbangping@163.com
Yong
Qiu
Q
Bin
Wang
W
Yang
Yu
Y
Ze-zhang
Zhu
Z
D000293:Adolescent; D000328:Adult; D020516:Brachial Plexus Neuropathies / Q000209:etiology* / Q000628:therapy; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D010243:Paralysis / Q000209:etiology* / Q000628:therapy; D011379:Prognosis; D012600:Scoliosis / Q000628:therapy*; D014143:Traction / Q000009:adverse effects*