Pre-operative halo-pelvic traction for neurofibromatosis patients with severe proximal thoracic spinal deformity: Indications and early treatment outcome

• Main Authors: Chung, Weng Hong, Mihara, Y., Toyat, S.S., Chiu, C.K., Hasan, M.S., Saw, A., Chan, C.Y.W., Kwan, Mun Keong
• Format: Article
• Published: Malaysian Orthopaedic Association 2021
• Subjects: R Medicine; RA0421 Public health. Hygiene. Preventive Medicine
• Online Access: http://eprints.um.edu.my/35831/; https://www.scopus.com/inward/record.uri?eid=2-s2.0-85122070283&doi=10.5704%2fMOJ.2111.015&partnerID=40&md5=c49abdb7f4fbae5124189baf85caf507

Introduction: To report the indications and early treatment outcomes of pre-operative halo-pelvic traction in patients with neurofibromatosis associated with severe proximal thoracic (PT) spinal deformity. Materials and methods: We reviewed four patients with neurofibromatosis with severe PT spinal deformity. Case 1, a 16-year-old male presented with severe PT kyphoscoliosis (scoliosis: 89°, kyphosis: 124°) and thoracic myelopathy. Case 2 was a 14-year-old, skeletally immature male who presented with a PT lordoscoliosis (scoliosis: 85°). Case 3, a 13-year-old male, presented with severe PT kyphoscoliosis (scoliosis: 100°, kyphosis: 95°). Case 4, a 35-year-old gentleman, presented with severe PT kyphoscoliosis (scoliosis: 113°, kyphosis: 103°) and thoracic myelopathy. All patients underwent pre-operative halo-pelvic traction. After a period of traction, all patients underwent posterior spinal fusion (PSF) with autologous bone grafts (local and fibula bone grafts) and recombinant human bone morphogenetic protein-2 (rhBMP-2). Results: Both patients with thoracic myelopathy regained near normal neurological status after halo-pelvic traction. Following traction, the scoliosis correction rate (CR) ranged from 18.0 to 38.9, while the kyphosis CR ranged from 14.6 to 37.1. Following PSF, the scoliosis CR ranged from 24.0 to 58.8, while the kyphosis CR ranged from 29.1 to 47.4. The total distraction ranged from 50-70mm. Duration of distraction ranged from 26-95 days. The most common complication encountered during halo-pelvic traction was pin-related e.g. pin tract infection, pin loosening and migration, osteomyelitis, and halo-pelvic strut breakage. No patients had cranial nerve palsies or neurological worsening. Conclusion: Pre-operative correction of severe PT spinal deformities could be performed safely and effectively with the halo-pelvic device prior to definitive surgery. © 2021, Malaysian Orthopaedic Association. All rights reserved.