General Session: Pediatric Spine
Presented by: P. Sudarsan - View Audio/Video Presentation (Members Only)
H. Suthar(1), M. Yarlagadda(1), C. Chikhale(1), M. Jindal(1), S. Hegde(1), P. Sudarsan(2)
(1) Apollo Hospitals, Orthopaedics, Chennai, India
Background: The use of intraoperative traction to facilitate pre-instrumentation curve correction and subsequent screw insertion is not widely practice. We analyzed the impact of intraoperative traction as a strategy to optimize implant placement and improve the curve correction in adolescent idiopathic scoliosis.
Purpose: To study the role of traction to decrease the apical rotation facilitates concave apical instrumentation and final curve correction.
Methods: We reviewed retrospectively collected data of patients were consecutively operated at our center by a single surgeon. Group A includes patients were operated during 2008-2011 without intraoperative traction and Group B between 2011-2013 with Skull tong and bilateral skin traction (Traction with 15% of body weight at skull tongs and 10-15% on each leg). Radiological parameters like apical rotation, concave apical screws density and correction of cobb angle and functional outcomes with SRS 22 questioners.
Results: Group A (no traction) had 72 patients (86% female) with a mean age of 15.5 years. Group B (traction) had 84 patients (88% female) with a mean age of 14.2 yrs. In group A pre-op mean major Cobb's angle was 62.8 degree and final correction to 19.5 degree (71% correction). Group B - Pre-op mean major Cobb's angle was 78.3 degreewhich reduced to 48.5 degree (38% correction) on traction film and final correction to 13.5 degree(83% correction, p< 0.001). Apical vertebral rotation changed from mean Nash-Moe grade of 2.6 to 2.2 with traction (p=0.011). Concave apical implant density (CAID) was calculated by apical concave sided implant ratio in apical and adjacent vertebra, measured as 87% under traction compared to 26% without (p< 0.0001). SRS-22 postoperative outcomes showed mean final score of 4.3 in group A and 4.38 in group B with no statistical difference between the groups (p=0.66). No complication in relation to traction was observed in group B.
Conclusion: Intraoperative traction decreased apical vertebral rotation, allowed for easier placement of apical screws improving the implant density and final curve correction. This technique obviates the need for complex osteotomy techniques and excessive correction manoeuvres to correct larger curves.