AIS Osteotomies Pedicle Screws Posterior Spinal Fusion Traction

Blog Post: Severe Scoliosis Treated with Preoperative Halo-Gravity Traction and Posterior Spinal Fusion


Above is an 11 year-old female with severe, untreated scoliosis of 143 degrees. Notice the severe shortening of the distance between her arms and hips. There is significant diminution of her lung volumes due to the shortening. With simply laying down on her back, the deformity improves to 104 degrees and if some force applied to her body, the deformity decreases to 86 degrees (called a “push prone view” where radiology technologists done lead gloves and push in three places to induce a corrective force to the body/spine).

The patient underwent general anesthesia and had a 6-pin halo applied to her skull.  Gradually distraction weight was added and on the above images, there is 35 lbs. of traction on her halo/spine.  The scoliosis has decreased to 92 degrees, a nice improvement to the 143 degrees prior to traction. 

Before surgery, supine side-bending radiographs are obtained, to the left and right side to evaluate the spine’s flexibility.

After 6 weeks of halo-gravity traction, the patient returned to the operating room for the definitive surgery. After the surgical approach, the spine was loosened with posterior column osteotomies from T5-T8 and T9-T12, the areas of maximal deformity.  This permits the correction to be safer with lower risk to the implants failing.  Pedicle screws were then placed from T2-L4 and using 6.0 mm Cobalt Chrome rods the deformity was corrected as much as safely could be accomplished.  The overall or global spine balance is excellent.

The 2nd and 4th from the left images are on Postoperative Day #3 at discharge from the hospital. Her recovery was uneventful.  On the measurements of the radiographs the distance between T1 and S1, which is between the neck and pelvis increased 90 mm or 3.5 inches!  Also, note how much better the lung volumes appear with the ribs being more symmetric on the left and right sides.

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