title: Preoperative short-term traction prior to posterior vertebral column resection: procedure and role.
abstract: OBJECTIVE
  Severe rigid spine deformity with sharp curve can be effectively corrected by posterior vertebral column resection (PVCR). Meanwhile, high risk of this procedure also has been recognized generally. The aim of this study is to review and evaluate the role of preoperative skull-femoral traction prior to PVCR for extremely severe rigid spinal deformity with sharp angular curve >150°.
  
  
  METHODS
  Twelve cases with extremely severe rigid deformities and sharp curves were treated by skull-femoral traction before operation. For them, the mean preoperative major scoliotic curve and kyphosis were 153° (110°-168°) and 109° (61°-180°). Continuous skull-femoral traction in supine position was started 4 weeks before operation. In the process of traction, tolerance, neurologic status, deformity changes, etc., were reviewed and documented for analysis. PVCR were performed in all these patients for final and main correction.
  
  
  RESULTS
  The final traction force in the 12 cases was 63% of body weight. After 4-week traction, the main scoliotic curve and kyphosis were decreased by 34 and 31%. In 1 week, main scoliotic curve and kyphosis were decreased by 19 and 15%. In 2 weeks, the major scoliosis curve was decreased by 11%, but kyphosis was unexpectedly increased by 4%. Deformity in the last 2 weeks was less significant than the first 2 weeks. After PVCR, the main scoliotic curve and kyphosis were improved 69 and 66%. No permanent neurological damage occurred.
  
  
  CONCLUSIONS
  Preoperative skull-femoral traction effectively mitigates the neurological risks of PVCR for extremely severe rigid spinal deformity with sharp curve. During traction, scoliosis can be improved more significantly and easily than kyphosis.
authors.affiliation: Department of Orthopaedics, The 2nd Affiliated Hospital of Kunming Medical University, 374# Dianmian Road, Kunming, 650101, Yunnan, People's Republic of China.
authors.forename: Yingsong
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Orthopaedics, The 2nd Affiliated Hospital of Kunming Medical University, 374# Dianmian Road, Kunming, 650101, Yunnan, People's Republic of China. xiejingming@vip.163.com.
authors.forename: Jingming
authors.initials: J
authors.lastname: Xie
authors.affiliation: Department of Orthopaedics, The 2nd Affiliated Hospital of Kunming Medical University, 374# Dianmian Road, Kunming, 650101, Yunnan, People's Republic of China.
authors.forename: Zhi
authors.initials: Z
authors.lastname: Zhao
authors.affiliation: Department of Orthopaedics, The 2nd Affiliated Hospital of Kunming Medical University, 374# Dianmian Road, Kunming, 650101, Yunnan, People's Republic of China.
authors.forename: Tao
authors.initials: T
authors.lastname: Li
authors.affiliation: Department of Orthopaedics, The 2nd Affiliated Hospital of Kunming Medical University, 374# Dianmian Road, Kunming, 650101, Yunnan, People's Republic of China.
authors.forename: Yin
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Orthopaedics, The 2nd Affiliated Hospital of Kunming Medical University, 374# Dianmian Road, Kunming, 650101, Yunnan, People's Republic of China.
authors.forename: Ni
authors.initials: N
authors.lastname: Bi
authors.affiliation: Department of Orthopaedics, The 2nd Affiliated Hospital of Kunming Medical University, 374# Dianmian Road, Kunming, 650101, Yunnan, People's Republic of China.
authors.forename: Zhiyue
authors.initials: Z
authors.lastname: Shi
authors.affiliation: Department of Orthopaedics, The 2nd Affiliated Hospital of Kunming Medical University, 374# Dianmian Road, Kunming, 650101, Yunnan, People's Republic of China.
authors.forename: Yunhua
authors.initials: Y
authors.lastname: Cai
authors.affiliation: Department of Orthopaedics, The 2nd Affiliated Hospital of Kunming Medical University, 374# Dianmian Road, Kunming, 650101, Yunnan, People's Republic of China.
authors.forename: Yuhao
authors.initials: Y
authors.lastname: Zhang
mesh_terms: D000293:Adolescent; D001139:Arnold-Chiari Malformation / Q000150:complications; D002648:Child; D005260:Female; D006801:Humans; D007738:Kyphosis / Q000209:etiology / Q000601:surgery*; D008297:Male; D008382:Marfan Syndrome / Q000150:complications; D009436:Neural Tube Defects / Q000150:complications; D017253:Neurofibromatoses / Q000150:complications; D019635:Neurosurgical Procedures; D019637:Orthopedic Procedures; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D012600:Scoliosis / Q000209:etiology / Q000601:surgery*; D013595:Syringomyelia / Q000150:complications; D014143:Traction / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Posterior vertebral column resection; Skull-femoral traction; Spinal deformity