Pre-operative Halo-Pelvic Traction for Neurofibromatosis Patients with Severe Proximal Thoracic Spinal Deformity: Indications and Early Treatment Outcome.

Content Provider	Europe PMC
Author	Chung, WH Mihara, Y Toyat, SS Chiu, CK Hasan, MS Saw, A Chan, CYW Kwan, MK
Copyright Year	2021
Abstract	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.
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ISSN	19852533
Journal	Malaysian Orthopaedic Journal [Malays Orthop J]
Volume Number	15
PubMed Central reference number	PMC8667250
Issue Number	3
PubMed reference number	34966502
e-ISSN	2232111X
DOI	10.5704/moj.2111.015
Language	English
Publisher	Malaysian Orthopaedic Association
Publisher Date	2021-11-01
Publisher Place	Kuala Lumpur
Access Restriction	Open
Rights License	This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited © 2021 Malaysian Orthopaedic Association (MOA). All Rights Reserved
Subject Keyword	halo-pelvic traction neurofibromatosis proximal thoracic deformity
Content Type	Text
Resource Type	Article
Subject	Orthopedics and Sports Medicine Emergency Medicine Surgery