THE USE OF INTRA-OPERATIVE SKULL-FEMORAL TRACTION IN THE CORRECTION OF SCOLIOSIS

Abstract

Purpose: To determine whether skull-femoral traction is a predictor of final surgical correction in scoliosis surgery and obviates the need for anterior release in severe deformities

Methods: 20 patients underwent skeletal femoral traction with a maximum of 50% of their body weight with the use of supracondylar femoral pins. A unilateral pin was used in the presence of pelvic obliquity and bilateral pins in patients with a neutral pelvis. Counter traction was applied through Gardner Well tongs at approximately one third the weight. Pre-op radiographs were compared with dynamic films, intra-op traction films and immediate and final post-operative films. Complications related to traction were recorded. All patients underwent posterior alone surgery for their scoliosis corrections.

Results: The mean curve magnitude was 80.3 degrees. NO anterior releases were performed. Intra-operative traction provided a mean correction of 60%. Final surgical correction was 70%. Level pelvis was achieved in all patients with pelvic obliquity. Traction provided up to 80% of the final correction in older adult scoliotics (> 50 yo) thus minimizing the force required on the pedicle screws to achieve correction. No traction related complications occurred.

Conclusions: Intra-op skull-femoral traction aides in the correction of severe scoliotic curves. Excellent corrections were achieved without the need for anterior releases. Traction reduced pelvic obliquity in the neuromuscular patients. Reducing the magnitude of the curves facilitated exposure of the posterior spine and minimized forces applied to the pedicle screws during scoliosis correction.