Analysis of Patients With Nonambulatory Neuromuscular Scoliosis Surgically Treated to the Pelvis With Intraoperative Halo-Femoral Traction

Study Design. Retrospective case-control study. Objectives. To compare patients treated with and without intraoperative halo-femoral traction to assess neuromuscular spinal deformity correction as well as the safety of the technique. Summary of Background Data. Optimal sitting balance can be achieved in nonambulatory neuromuscular patients with pelvic obliquity by maneuvering a Galveston-type rod or inserting screws into the iliac wings; however, this is often clinically challenging because of the small, soft bone-stock in the pelvis of these patients. Methods. A total of 40 patients with nonambulatory neuromuscular scoliosis were treated surgically with a T2 or T3-sacrum instrumented posterior spinal fusion. There were 20 patients (12 who underwent posterior spinal fusion-alone and 8 anterior/posterior spinal fusion) who had intraoperative halo-femoral traction performed unilaterally on the high side iliac wing compared to a control group of 20 patients (15 who underwent posterior spinal fusion-alone and 5 anterior/posterior spinal fusion) operatively treated without halo-femoral traction. Each group had 14 patients with spastic (cerebral palsy) scoliosis, and 6 with flaccid (muscular dystrophy) scoliosis deformities. Minimum follow-up for all patients was 2 years (range 3–12). Results. Preoperative lumbar scoliosis averaged 87° (range 30°–141°) in the halo-femoral traction group and 67° (range 28°–108°) in the control group (P = 0.012). Postoperative lumbar Cobb decreased to 35° (range 15°–60°) in the halo-femoral traction group and 32° (range 4°–66°) in the control group (P = 0.181). Preoperative pelvic obliquity averaged 26° (range 8°–47°) in the halo-femoral traction group and 17° (range 8°–44°) in the control group (P = 0.017); postoperative averaged 6° (range 1°–23°) in the halo-femoral traction group and 7° (range 0°–27°) in the control group. Average pelvic obliquity correction was 78% in the halo-femoral traction group and 52% in the control group (P = 0.001). There were no intraoperative or postoperative halo-femoral traction apparatus- related complications noted (pin cut-out, femoral fractures, pin-sight infections, etc.). Conclusions. Intraoperative use of halo-femoral traction during the surgical treatment of patients with nonambulatory neuromuscular scoliosis provided significantly improved lumbar curve and pelvic obliquity correction. Intraoperative halo-femoral traction had no associated perioperative complications.