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Intraoperative Skull-Femoral (Skeletal) Traction in Surgical Correction of Severe Scoliosis (>80°) in Adult Neglected Scoliosis

Kulkarni, Arvind G., MS*; Shah, Sambhav P., MS

doi: 10.1097/BRS.0b013e318277c874

Study Design. Retrospective review.

Objective. To evaluate the effectiveness, safety, and reliability of intraoperative skeletal traction in the surgical correction of severe adult neglected scoliosis.

Summary of Background Data. Literature shows that curves more than 80° that do not reduce to 50° to 55° on bending radiographs require an anterior release. A combined anterior and posterior approach is often used for treating severe rigid scoliosis. However, anterior approach has its own complications in the form of increased morbidity, increased blood loss, operative time, and pulmonary complications. Corrective surgery gets even more challenging if the patients are adults.

Methods. Ten patients with severe scoliosis (>80°) and low flexibility index (<0.5) treated with intraoperative skeletal traction were part of this study. The patients were operated between April 2008 and May 2010. Eight patients with neglected adolescent idiopathic scoliosis and 2 with neuromuscular scoliosis were included. The mean age was 27.4 years (19–36). Corrective surgery and fusion was performed using intraoperative skeletal traction.

Results. The Cobb angle improved from a mean of 89.35° preoperatively to 40.25° postoperatively giving a mean correction of 55.29%. Apical vertebral rotation (Nash and Moe) improved from a mean of grade 3(2–4) to a mean of grade 2(1–3). Apical vertebral translation improved from a mean of 2.19 cm preoperatively to 0.98 cm postoperatively (55.41% correction). There were no intraoperative adverse events or postoperative complications. All patients had good shoulder balance and were satisfied with the correction achieved.

Conclusion. Intraoperative skull-femoral traction can be a safe and effective method to assist correction of severe and rigid scoliosis. It facilitates surgical exposure and pedicle screw insertion. It obviates the need of an anterior release surgery and associated morbidity, thus reducing the hospital stay and costs. It provides a much simpler way to correct the sagittal and coronal imbalance, as well as the pelvic obliquity.

Rigid severe curves often require extensively morbid procedures for curve correction. By using intraoperative skeletal traction, we were able to achieve 55.29% correction only via a posterior approach. It not only provided a simpler way to correct the deformity and the pelvic obliquity but also facilitated screw insertion and surgical exposure.

*Mumbai Spine Scoliosis & Disc Replacement Centre; and

Department of Orthopaedics, Bombay Hospital & Medical Research Centre, Mumbai, India.

Address correspondence and reprint requests to Arvind G. Kulkarni, MS, Mumbai Spine Scoliosis & Disc Replacement Centre, Bombay Hospital & Medical Research Centre, Room Nos 206, 12, New Marine Lines, 2nd Floor, Mumbai 400020; E-mail:

Acknowledgment date: March 23, 2012. First revision date: July 8, 2012. Second revision date: September 1, 2012. Acceptance date: September 30, 2012.

The legal regulatory status of the device(s)/drug(s) that is/are the subject of this manuscript is not applicable in my country.

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

© 2013 Lippincott Williams & Wilkins, Inc.