“Internal Dis-traction”

The last 4 posts have been on spine traction, and this is the last one, which details the third type traction we use in pediatric and adolescent spine deformity surgery: Temporary Intra-operative Distraction Rods (TIDR).  This type of traction, like Halo-Gravity and Intraoperative Halo-Femoral Traction, are used for the correction of severe scoliosis.  Each of these have positives and negatives.  In general, in most instances in which halo traction is considered for a thoracic or lumbar spinal deformity, TIDR may be also be considered.  The only absolute requirement is the presence of sufficient temporary bony fixation points in which to anchor the rods near the top and bottom of the deformity.  Anchor points may include the spine, pelvis or ribs.  This technique can be utilized in situation with cervical problems (i.e. deformity or instability) or distal deformity (i.e. hip flexion deformity). 

 

This picture shows how the upgoing rib hooks are positioned and push upwards (red arrow).  By pushing up on the ribs, which are attached to the spine, the scoliosis is stretched straighter. 

 

 

 

 

 

The below case is a 14 year old with severe idiopathic scoliosis of 110 degrees, for which the Temporary Intra-operative Distraction Rods (TIDR) was used during surgery. 

 

The first stage of the surgery was to expose the spine, perform osteotomies (to loosen up the spine and get better scoliosis correction) and place the TIDR.  In this case we placed 4 rib hooks (green arrows in intraoperative photos and green circle on accompanying x-ray).  When we distract the rod (direction of blue arrows) you can see how much correction was obtained (110 degrees down to 61 degrees), when compared to the above x-ray before surgery.

The patient was brought back one week later to complete the surgery, which was to remove the TIDR and place two new spinal rods (and get more correction).  The final scoliosis measurement is 40 degrees!  A huge correction!

 

We don’t need to use this technique often, but when we do it can often be extremely helpful!