The use of skin traction as an intraoperative adjunct for correction during pediatric neuromuscular scoliosis correction.

Purpose: Intraoperative traction can improve deformity correction during posterior spinal fusion (PSF). This is commonly done with invasive distal femoral or pelvic pins, or traction boots. The novel technique of intraoperative skin traction (ISkinT) avoids risks associated with intraoperative skeletal traction (ISkelT) or hyperlordosis with extended hip position. We aimed to describe ISkinT and assess its safety and efficacy in PSF in non-ambulatory scoliosis.

Methods: Retrospective review of patients aged 10-21yo who underwent T2-pelvis PSF with ISkinT from 2017 to 2023. Demographics and radiographic measurements were statistically compared to a published cohort that used ISkelT.

Results: 42 patients treated with ISkinT were included and compared to 41 patients treated with ISkelT. ISkinT was applied by a cranial attachment and an average of 12% body weight to the pelvis with the hips and knees flexed, using tape-rope-weight system with Trendelenburg assistance. The preop major Cobb was 90°±21° in the ISkinT cohort and 91°±17° in the ISkelT cohort (p = 0.743; d = 0.07), which corrected 75% in ISkinT and 53% in ISkelT (p < 0.0001; d = 1.3). Preop pelvic obliquity averaged 23°± 10° in ISkinT and 34°±14° in ISkelT that corrected 74% in ISkinT and 65% in ISkelT (p < 0.0001; d = 0.95). No intraop or postoperative skin traction-related complications occurred, including neuromonitoring complications (obtained in 88%).

Conclusion: In non-ambulatory neuromuscular pediatric scoliosis patients, ISkinT during PSF to the pelvis is a safe and effective technique for deformity correction. There were no associated complications and no difference of corrective capacity for ISkinT compared to ISkelT. ISkinT can be considered for T2-pelvis PSF for pediatric scoliosis.