title: The use of pre-operative halo traction to minimize risk for correction of severe scoliosis in a patient with Fontan circulation: a case report and review of literature.
abstract: Patients with Fontan circulation have increased cardio-respiratory risk during major spinal surgery. We report a case of severe scoliosis with a Cobb angle of 123.3° in a 16-year-old boy with Fontan circulation treated with single stage posterior segmental pedicle screw instrumentation and fusion.
  
  
  
  Case report.
  
  
  
  The use pre-operative halo-ring traction for a duration of 6 weeks in this case lead to improvement in cobb angle from 123.3°, kyphotic angle 87.1° to cobb angle of 78.0°, kyphotic angle 57.2° (on bending and stress films). The operation was completed in 150 min, blood loss 1050 ml (25 ml/kg), and cell salvage of 490 ml. He was immediately extubated post correction, but monitored in ICU for a day. Total length of stay was 8 days without any perioperative morbidity or allogeneic blood transfusion. Final post-operative radiograph showed a cobb angle of 44.2°, kyphotic angle 22.8°. Follow up at 27 months showed solid union with no significant loss of correction.
  
  
  
  From this case experience, pre-operative halo traction is a useful surgical strategy in patients with Fontan circulation with severe kyposcoliosis to achieve adequate correction without additional osteotomies to minimize the risk of surgical correction.
authors.affiliation: Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, 50603, Lembah Pantai, Kuala Lumpur, Malaysia. chrnat01@yahoo.com.
authors.forename: Chris Yin Wei
authors.initials: CY
authors.lastname: Chan
authors.affiliation: Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, 50603, Lembah Pantai, Kuala Lumpur, Malaysia.
authors.forename: Chiao Yee
authors.initials: CY
authors.lastname: Lim
authors.affiliation: Department of Anaesthesiology, Faculty of Medicine, University of Malaya, 50603, Lembah Pantai, Kuala Lumpur, Malaysia.
authors.forename: M
authors.initials: M
authors.lastname: Shahnaz Hasan
authors.affiliation: Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, 50603, Lembah Pantai, Kuala Lumpur, Malaysia.
authors.forename: Mun Keong
authors.initials: MK
authors.lastname: Kwan
mesh_terms: D000293:Adolescent; D018729:Fontan Procedure / Q000009:adverse effects*; D006801:Humans; D007738:Kyphosis / Q000473:pathology / Q000601:surgery; D008297:Male; D065289:Pedicle Screws; D011184:Postoperative Period; D011300:Preoperative Care / Q000379:methods; D012307:Risk Factors; D012600:Scoliosis / Q000473:pathology / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods*; D014143:Traction / Q000379:methods*; D016896:Treatment Outcome
keywords: Fontan Circulation; Halo Traction; Scoliosis