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. Preoperative halo-gravity traction
2. Intraoperative halo-femoral traction
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.
