An intraoperative laterally placed distractor for gradual load sharing correction of severe spastic neuromuscular spinal deformity.
PURPOSE: To analyze the overall deformity correction for severe neuromuscular scoliosis using laterally placed intra-operative distraction and compare to those receiving standard surgical technique.
METHODS: This was a retrospective, IRB-approved, cohort study of patients with GMFCS 4 or 5 spastic cerebral palsy with neuromuscular scoliosis, age greater than 10 years, who underwent posterior spinal fusion from 2007 to 2019. All patients had vectored cervical traction with Gardner-Wells tongs, with hips flexed in a relative sitting position. The study cohort underwent intraoperative, laterally placed correction using a distractor placed between two upper ribs and the ipsilateral greater trochanter while the control cohort did not. The 24 study patients were compared to 22 control patients.
RESULTS: Preoperative comparisons identified significant differences in Cobb angle, preoperative flexibility, and pelvic obliquity with the study group having larger, stiffer deformities with greater obliquity. There were no differences in pre-operative sagittal plane deformity. Mean post-operative upright Cobb angle correction was 67.3° ± 14.8° in the study and 55.3° ± 9.9° in the control group, representing a 66% and 60% correction, respectively. No neurological or other complications were noted from the use of this technique.
CONCLUSION: The use of a laterally placed distraction device from upper ribs to ipsilateral greater trochanter allowed gradual lateral un-bending of large stiff neuromuscular spine deformities with greater correction than that of standard technique. In this small series, the technique allowed load-sharing during correction, with hips remaining in a functional sitting position, and without neurological complications.
LEVEL OF EVIDENCE: Level III-retrospective cohort study.
Distraction; Neuromuscular; Posterior fusion; Scoliosis; Spinal deformity
Bachman DR, Singh LK, Anderson JT, Schwend RM. An intraoperative laterally placed distractor for gradual load sharing correction of severe spastic neuromuscular spinal deformity. Spine Deform. 2021;9(4):1137-1144. doi:10.1007/s43390-021-00316-4