Vincent Arlet, Patrice Papin, Dante Marchesi
August 1999, Volume 8, Issue 4, pp 329 - 331 Ideas and technical innovations Read Full Article 10.1007/s005860050182
First Online: 05 August 1999
In severe congenital scoliosis, traction (whether with a halo or instrumental) is known to expose patients to neurologic complications. However, patients with restrictive lung disease may benefit from halo traction during the course of the surgical treatment. The goal of treatment of such deformities is, therefore, twofold: improvement of the respiratory function and avoidance of any neurologic complications. We report our technique to treat a 17-year-old girl with a multi-operated congenital scoliosis of 145 ° and cor pulmonale. Pre-operative halo gravity traction improved her vital capacity from 560 cc to 700 cc, but led to mild neurologic symptoms (clonus in the legs). To avoid further neurologic compromise, her first surgery consisted of posterior osteotomies and the implantation of two sliding rods connected to loose dominoes without any attempt at correction. Correction was then achieved over a 3-week period with a halofemoral traction. This allowed the two rods to slide while the neurologic status of the patient was monitored. Her definitive surgery consisted of locking the dominoes and the application of a contralateral rod. Satisfactory outcome was achieved for both correction of the deformity (without neurologic sequels) and improvement of her pulmonary function (1200 cc at 2 years). This technique using sliding rods in combination with halofemoral traction can be useful in high-risk, very severe congenital scoliosis.
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