Retrospective review of prospective cohort.
We sought to examine the role of halo gravity traction (HGT) in reducing preoperative surgical risk.
The impact of HGT on procedure choice, preoperative risk factors, and surgical complications has not been previously described.
Patients treated with HGT before primary surgery were included. The FOCOS Score (FS) was used to quantify operative risk. FS was calculated using patient-factors (ASIA, body mass index, etiology), procedure-factors (PcF; osteotomy planned, number of levels fused, etc.), and curve magnitude (CM). Scores ranged from 0 to 100 with higher scores indicating increased risk. FS was calculated before and after HGT to see how changes in FS affected complication rates.
A total of 96 patients were included. Halo-related complications occurred in 34% of patients but revision was required in only 8.3%. Average FS improved by 18 points after HGT. CM, PcF, and patient-factors all improved (P < 0.05). The greatest changes were in CM and PcF. The planned rate of three-column osteotomies dropped from 91% to 38% after HGT. FS (area under the curve [AUC]: 0.68, P = 0.023) and change in FS (AUC: 0.781, P < 0.001) was successfully able to predict the rate of surgical complications. A preoperative FS of 74 was identified as a cut-off for a higher rate of surgical complications (sensitivity 58.8%, specificity 74.7%). Patients with a reduction in FS < = 10pts were five times more likely to have a complication (relative risk 5.2, 95% confidence interval: 1.9–14.6, P < 0.001). A multivariate regression showed that change in FS was an independent predictor of complication rates (P < 0.05).
FS can successfully predict surgical risk in pediatric patients with complex spinal deformity. Preoperative HGT can reduce FS and surgical risk by improving CM, lowering three-column osteotomies use, and improving body mass index. A reduction in FS after HGT predicts a lower rate of surgical complications.
Level of Evidence: 3
FOCOS Score (FS) can successfully predict surgical risk in pediatric patients with complex spinal deformity. Preoperative halo gravity traction can reduce FS and surgical risk by improving curve magnitude, lowering three-column osteotomies use, and improving body mass index. A reduction in FS after halo gravity traction predicts a lower rate of surgical complications.
∗Hospital for Special Surgery, New York, NY
†FOCOS Orthopaedic Hospital, Accra, Ghana
‡Korle-Bu Teaching Hospital, Accra, Ghana.
Address correspondence and reprint requests to Oheneba Boachie-Adjei, MD, DSc, FOCOS Orthopaedic Hospital, No. 8 Teshie Street, Pantang, Accra, P.O. Box KD 779, Kanda-Accra; E-mail: firstname.lastname@example.org; email@example.com
Received 2 August, 2018
Accepted 14 September, 2018
The manuscript submitted does not contain information about medical device(s)/drug(s).
K2M (Grant No: K2M/FC/060216) grant funds were received in support of this work.
Relevant financial activities outside the submitted work: consultancy, grants.
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