15. 术前halo-gravity牵引矫正颈椎后凸畸形的疗效及安全性

IF 2.5 Q3 Medicine

North American Spine Society Journal Pub Date : 2025-07-01 DOI:10.1016/j.xnsj.2025.100709

Hao-Wen Chen MD, PhD

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引用次数: 0

摘要

背景：严重的颈椎后凸畸形由于神经系统并发症和次优预后的风险，在脊柱矫正手术中提出了重大挑战。晕重力牵引（HGT）已被提出作为术前策略，通过逐渐调整脊柱来改善预后，特别是用于纠正严重的后凸畸形；然而，是否将HGT作为常规策略仍然存在争议。目的本研究旨在通过比较术前牵引和不牵引的手术效果，评估术前HGT在严重颈椎后凸畸形矫形手术中的有效性和安全性。研究设计/设置在医疗中心进行的回顾性队列研究患者样本：50例重度颈椎后凸患者入组并分为两组：25例在首次矫正手术前接受数天的术前HGT， 25例在不进行HGT的情况下直接矫正手术。结果测量包括总矫正Cobb角、疼痛缓解（视觉模拟量表，VAS）、功能改善(Oswestry残疾指数，ODI；和日本骨科协会，JOA评分)和安全性（神经功能缺损率）。方法采用Student’st检验、卡方检验和logistic回归模型进行统计学分析。结果HGT组Cobb角矫正效果明显优于对照组(平均改善35.2°vs 28.5°，p <；0.01)，更优异的疼痛缓解(VAS评分降低：5.8 vs 4.2, p <；0.01)，功能改善增强(ODI降低：26.7% vs 18.3%；JOA评分改善：3.5 vs 2.4, p <；0.05)。此外，HGT组的神经系统并发症发生率较低(4% vs 16%, p <；0.05)。结论shgt是治疗中重度颈椎后凸畸形的一种安全有效的辅助策略，手术效果好，并发症少。建议在适当的情况下常规实施术前HGT，以优化畸形矫正和患者安全。FDA器械/药物状态anjon Bremer Halo系统（K171863）（已批准用于此适应症）。

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15. Efficacy and safety of preoperative halo-gravity traction in cervical kyphotic deformity correction

BACKGROUND CONTEXT

Severe cervical kyphotic deformities present a significant challenge in spinal correction surgery due to the risks of neurological complications and suboptimal outcomes. Halo-gravity traction (HGT) has been proposed as a preoperative strategy to improve outcomes by gradually realigning the spine, especially for correcting severe kyphotic deformities; however, whether applying HGT as a routine strategy remains controversial.

PURPOSE

This study aims to evaluate the effectiveness and safety of preoperative HGT in patients undergoing corrective surgery for severe cervical kyphotic deformities by comparing surgical outcomes with and without preoperative traction.

STUDY DESIGN/SETTING

Retrospective cohort study conducted at a medical center

PATIENT SAMPLE

Fifty patients with severe cervical kyphosis were enrolled and divided into two groups: 25 received preoperative HGT for several days before primary correction surgery, and 25 underwent direct correction surgery without HGT.

OUTCOME MEASURES

Outcomes measured included total corrected Cobb’s angle, pain relief (visual analog scale, VAS), functional improvement (Oswestry Disability Index, ODI; and Japanese Orthopaedic Association, JOA score), and safety (rate of neurological deficits).

METHODS

Statistical analysis, including Student's t-test, Chi-square, and logistic regression model, were performed to compare these parameters between groups.

RESULTS

The HGT group demonstrated significantly better correction of Cobb angle (mean improvement of 35.2° vs 28.5°, p < 0.01), more excellent pain relief (VAS score reduction: 5.8 vs 4.2, p < 0.01), and enhanced functional improvement (ODI reduction: 26.7% vs 18.3%; JOA score improvement: 3.5 vs 2.4, p < 0.05). Furthermore, the rate of neurological complications was lower in the HGT group (4% vs 16%, p < 0.05).

CONCLUSIONS

HGT is an effective and safe adjunctive strategy for managing moderate to severe cervical kyphotic deformities, leading to superior surgical outcomes and reduced complications. Routine implementation of preoperative HGT is recommended in appropriate cases to optimize deformity correction and patient safety.