BACKGROUND: Halo traction is a well-recognized adjunct for
correcting severe, complex, rigid scoliotic curves, but it is associated with
complications and is contraindicated in the presence of fixed cervical
instability, kyphosis, or stenosis. In addition, halo traction often requires
prolonged hospital stays and is not welcomed by all families. These
limitations led to consideration of temporary internal distraction as an
METHODS: We retrospectively reviewed the records of children in whom
severe scoliosis had been treated with temporary internal distraction. Our
goals were to (1) assess whether the use of temporary internal distraction can
aid in the correction of severe scoliosis and (2) identify complications
associated with temporary internal distraction and compare them with those
associated with halo traction. The mean preoperative curve was 104°. All
patients underwent initial posterior release of the rigid portion of the spine
(with six also having anterior release) and placement of spinal
instrumentation under distraction during spinal cord monitoring. Of the ten
patients, four had one distraction procedure (i.e., the initial surgery [or
first distraction]) followed by definitive fusion and the remaining six had
two distraction procedures (i.e., the initial surgery [or first distraction]
followed by the second distraction) followed by definitive fusion. After
distraction, all patients underwent posterior spinal fusion with definitive
dual-rod fixation. The amount of correction was determined by measuring the
curve on plain radiographs made preoperatively, after each internal
distraction procedure, after definitive fusion, and at the time of final
RESULTS: Curve correction after use of internal distraction, and
before definitive fusion, averaged 53% (from 104° to 49°) (range, 39%
[from 70° to 43°] to 79% [from 70° to 15°]). This method
facilitated safe, gradual deformity correction in all ten patients. The mean
time between the initial procedure and the definitive fusion was 2.4 weeks.
The mean final curve correction was 80% (from 104° to 20°) (range, 73%
[from 131° to 35°] to 91% [from 110° to 10°]). No neurologic
deficits or infections resulted.
CONCLUSIONS: Temporary internal distraction is a viable alternative
approach to maximizing curve correction in patients undergoing spinal fusion
for severe scoliosis.
LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.
ORIGINAL ABSTRACT CITATION: "Temporary Internal Distraction as an Aid
to Correction of Severe Scoliosis"