Intraoperative Halo-femoral Traction Part 2

 In nonambulatory neuromuscular scoliosis (i.e. cerebral palsy, spinal muscle atrophy, myelomeningocoele, muscular dystrophy) progressive scoliosis with long, sweeping curves can cause significant tipping of the hips which can create sitting imbalance, pressure sores and pain. 

 

12 year old female with spastic quadriplegic CP

 

The goal of surgical treatment for this population is different than for the idiopathic scoliosis patient, specifically to correct the tilt of the hips and to obtain, and maintain, a painless, well-balanced spine above the pelvis.  Hence the aim is to establish a good sitting balance, as you see below.

 

 

 

 

 

 

Here she is now 5 years after surgery

 

The major challenge in the surgical correction of neuromuscular scoliosis is how to obtain spinal correction and, secondarily, how to maintain this alignment during the postoperative period. 

 Soft bones is a common problem which poses challenges in how to obtain spinal correction. 

 The use of intraoperative halo-femoral traction (IHFT) allows direct skeletal traction and correction of the spinal deformity and pelvic obliquity. 

 

Pulling up on the halo helps center the head over the hips, and pulling down on the hip that is higher helps level the hips.

 

During the surgical procedure most, if not all, the correction is obtained by the IHFT obviating the need for significant spinal implant manipulation for correction. 

 

In this 13 year old female with spastic quadriplegic cerebral palsy, who in the second x-ray is in surgery, it is easy to see how the scoliosis is improved and the hips more level, simply due to traction.

 

By off-loading the implants the chance of loosening losing fixation at the bone-implant interface is lessened.

 

Here the patient is 5 years after surgery with excellent three-dimensional spine position and a solid spine fusion.