Pre-operative Traction in Severe Rigid Kyphoscoliosis - CT-based Navigation Pelvic Pin Insertion in Halo-Pelvic Traction: A Case Report.

Abstract

Neglected severe rigid kyphoscoliosis can lead to rapid curve progression, presenting a challenge for surgical correction and carrying higher risks of mortality, morbidity, and neurological injury, potentially resulting in permanent paralysis. Halo-pelvic traction (HPT) has been reported to be effective in improving curve flexibility, assisting the surgical correction process, and reducing the likelihood of neurological complications. We report the case of a 15-year-old girl with mosaic Turner syndrome and severe kyphoscoliosis, who experienced progressive curve progression (from 41° to 158°) over a span of 6 years. Preoperative halo gravity traction (HGT) was unsuccessful. To address this deformity, HPT was performed with CT-based navigation for pelvic pin insertion, considering her relatively small pelvis and pelvic obliquity. This technique allowed for precise pin placement, reducing the risk of injury to major arteries, nerves, and abdominal/pelvic organs, while enabling the creation of a more versatile halo-pelvic frame designed to enhance patient comfort and mobility. The patient underwent weekly distraction using HPT for 4 weeks, during which her coronal Cobb angle reduced from 158° to 103° and her kyphotic angle decreased from 90° to 64°. With this notable improvement in the primary spinal curvature, we proceeded with posterior spinal fusion. Notably, this approach obviated the need for vertebral column resection. As a result, we achieved a correction rate of 53.8% in the coronal Cobb angle and 55.6% in the kyphotic angle without neurological injury.