Staged short-term modified halo-pelvic traction and posterior spinal fusion versus posterior vertebral column resection for severe rigid kyphoscoliosis: a multicenter comparative study.

Abstract

Background context: Surgical correction of severe rigid kyphoscoliosis remains technically challenging and is associated with high complication rates. Posterior vertebral column resection (pVCR) is often required for satisfactory correction but entails substantial surgical risks. Halo-pelvic traction (HPT) has been proposed as a safer alternative that may reduce the need for high-grade osteotomy by partially correcting the deformity preoperatively.

Purpose: To compare the clinical outcomes of HPT combined with posterior spinal fusion (HPT+PSF) versus pVCR for severe rigid kyphoscoliosis, focusing on deformity correction, surgical morbidity, pulmonary function, and complication profiles.

Study design/setting: Retrospective comparative effectiveness study conducted at two public tertiary referral hospitals in Beijing, China.

Patient sample: A total of 82 patients (41 per group) with severe rigid kyphoscoliosis (defined as coronal and/or sagittal Cobb angle >90° and flexibility <30%) treated between March 2016 and April 2023, with a minimum follow-up of 2 years.

Outcome measures: Primary outcomes included deformity correction, intraoperative variables, pulmonary function, and surgery-related complications. Secondary outcomes for the HPT+PSF group included traction duration, traction efficacy, and traction-related complications.

Methods: Patients received either HPT+PSF or pVCR based on surgical decision-making. Radiographic measurements were performed independently by two blinded observers. Comparative analyses of radiological and clinical outcomes were performed between groups.

Results: The mean duration of HPT was 4.7±1.4 weeks. The traction correction rates in the coronal and sagittal planes were 43%±10% and 39%±14%, respectively. 34% (14/41) of the patients experienced traction-related complications. The total correction rates in the coronal and sagittal planes were comparable between the HPT+PSF and pVCR groups. No significant difference between the groups at baseline or at the latest follow-up in terms of the pulmonary function indices. Compared to the pVCR group, the HPT+PSF group demonstrated significantly shorter surgical time, reduced estimated blood loss, lower incidence of intraoperative neurological monitoring alerts, and fewer surgery-related complications.

Conclusion: HPT+PSF provides deformity correction comparable to that of pVCR while significantly reducing surgical morbidity. It represents a viable and potentially safer alternative for patients with severe rigid kyphoscoliosis. However, the risk of traction-related complications and psychological stress necessitates further refinement of HPT protocols.