Blog Topic: The Use of Internal Distraction in Severe Scoliosis
In severe scoliosis, the use of traction has demonstrated an ability to improve the spinal deformity before surgery was actually performed. There are three main methods:
1. 1. Preoperative halo-gravity traction
2. 2. Intraoperative halo-femoral traction
3. 3. Intraoperative Internal Dis-Traction
This post will focus on #3: Intraoperative Internal Dis-Traction
To demonstrate this treatment we will use the case of a 13 year old female who has severe scoliosis measuring 105 degrees. Treatment thus far has been observation. She had been having daily back pain which prevented her from playing athletics.
Due to the severe scoliosis a total spine MRI was ordered and a thoracic syrinx was diagnosed (treated nonoperatively).
I call her type of scoliosis: neurogenic. Many surgeons will call this neuromuscular but I don’t think it is correct to included this type of patient into the same group as cerebral palsy, spina bifida, spinal muscle atrophy, etc….diagnoses.
The image, below far right, is a push prone. This image demonstrates that when a force is exerted on the spine the scoliosis improves from 105 degrees to 77 degrees.
On the below right sidebender (right side radiograph) the deformity decreases to 82 degrees.
Next are a picture and radiograph taken in surgery, which both demonstrate Intraoperative Internal Dis-Traction. After exposure of the spine multiple osteotomies (posterior column osteotomies or PCOs) are done to make the spine more flexible, and allow more correction of the scoliosis.
Then a few screws are placed in the lower part of the spine (red circle), then hooks are placed on 4 ribs on the concave side of the scoliosis (yellow circle). These two foundations are then connected by a rod and then distraction can be done to improve the scoliosis, which you can see it is much better than it was before surgery.
After this rod is placed the remainder of all the pedicle screws are inserted. Distraction is done multiple times to gradually improve the scoliosis. It is important to have spinal cord monitoring as the Dis-Traction can make the spinal cord not work normally.
In surgery the right rod is placed, then the Dis-Traction rod is removed, and a new left rod is placed. During the rod placements more and more and more correction is safely obtained.
The below radiographs demonstrated the postoperative correction, improved from 105 degrees to 38 degrees.
Overall a nice correction in both the front and side views of the spine.