Pre-operative Halo-Pelvic Traction for Neurofibromatosis Patients with Severe Proximal Thoracic Spinal Deformity: Indications and Early Treatment Outcome
https://doi.org/10.5704/MOJ.2111.015
- Author:
Chung WH
1
;
Toyat SS
1
;
Chiu CK
1
;
Hasan MS
2
;
Saw A
1
;
Chan CYW
1
;
Kwan MK
1
;
Mihara Y
1
,
3
Author Information
1. Department of Orthopaedic Surgery (NOCERAL), University of Malaya, Kuala Lumpur, Malaysia&
2. Department of Anaesthesiology, University of Malaya, Kuala Lumpur, Malaysia
3. Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu-shi, Japan
- Publication Type:Journal Article
- Keywords:
halo-pelvic, traction, neurofibromatosis, proximal thoracic, deformity
- From:Malaysian Orthopaedic Journal
2021;15(No.3):99-107
- CountryMalaysia
- Language:English
-
Abstract:
Introduction: To report the indications and early treatment
outcomes of pre-operative halo-pelvic traction in patients
with neurofibromatosis associated with severe proximal
thoracic (PT) spinal deformity.
Materials and methods: We reviewed four patients with
neurofibromatosis with severe PT spinal deformity. Case 1, a
16-year-old male presented with severe PT kyphoscoliosis
(scoliosis: 89°, kyphosis: 124°) and thoracic myelopathy.
Case 2 was a 14-year-old, skeletally immature male who
presented with a PT lordoscoliosis (scoliosis: 85°). Case 3, a
13-year-old male, presented with severe PT kyphoscoliosis
(scoliosis: 100°, kyphosis: 95°). Case 4, a 35-year-old
gentleman, presented with severe PT kyphoscoliosis
(scoliosis: 113°, kyphosis: 103°) and thoracic myelopathy.
All patients underwent pre-operative halo-pelvic traction.
After a period of traction, all patients underwent posterior
spinal fusion (PSF) with autologous bone grafts (local and
fibula bone grafts) and recombinant human bone
morphogenetic protein-2 (rhBMP-2).
Results: Both patients with thoracic myelopathy regained
near normal neurological status after halo-pelvic traction.
Following traction, the scoliosis correction rate (CR) ranged
from 18.0% to 38.9%, while the kyphosis CR ranged from
14.6% to 37.1%. Following PSF, the scoliosis CR ranged
from 24.0% to 58.8%, while the kyphosis CR ranged from
29.1% to 47.4%. The total distraction ranged from 50-70mm.
Duration of distraction ranged from 26-95 days. The most
common complication encountered during halo-pelvic
traction was pin-related e.g. pin tract infection, pin loosening
and migration, osteomyelitis, and halo-pelvic strut breakage.
No patients had cranial nerve palsies or neurological
worsening.
Conclusion: Pre-operative correction of severe PT spinal
deformities could be performed safely and effectively with
the halo-pelvic device prior to definitive surgery.
- Full text:16.2021my1207.pdf
