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Background: While vertebral column resections (VCRs) are an effective means for correcting severe spine deformities, these complex procedures are associated with high rates of complications. We hypothesized that preoperative halo-gravity traction (HGT) followed by spinal fusion without VCRs can produce equivalent outcomes with less risk than a VCR in complex pediatric spinal deformity.
Methods: Prospective multicenter data for pediatric patients who underwent spinal fusion for severe spinal deformities was reviewed. Patients treated with either (1) preoperative HGT without VCRs or (2) VCRs without preoperative HGT were included. Patients with congenital etiology and those with prior surgery were excluded. Comparisons were made between cohorts with respect to preoperative, intraoperative, and postoperative (two years) demographic, radiographic, and health-related quality of life (HRQoL) variables. The rate of revision surgery and any treatment complications were also compared.
Results: We identified 49 patients (mean age 16+2.9 years; 54% males) who underwent VCR (17/49; 35%) or preoperative HGT (32/49; 65%) for severe spinal deformities. Those in the HGT cohort had more severe deformity at baseline based on radiographic variables including maximum cobb angle, maximum kyphosis, major coronal cobb angle, and apical vertebral translation. They also had greater residual deformities at 2 years postoperatively, though percent correction of the maximum cobb angle (p=0.28), major (p=0.54) and minor (p=0.91) coronal curve, maximum kyphosis (p=0.86), and apical vertebral translation (p=0.66) was similar to the VCR cohort. Operative time (p=.18), estimated blood loss (0.37), hospitalization length (0.52), and ICU stay (0.12) were similar between cohorts, though patients who underwent VCR had higher rates of total complications (47% vs. 3%; p<0.01). There were no significant differences between cohorts with respect to percent change in HRQoL outcomes from baseline to 2 years postoperatively.
Conclusion: Our study suggests that in patients without congenital deformities undergoing primary deformity correction, preoperative HGT followed by spinal fusion produces radiographic outcomes that are similar to VCRs with fewer perioperative complications. Thus, preoperative HGT for severe pediatric deformities may lessen the need to perform higher risk VCRs.