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Surgical Techniques   |    
Temporary Internal Distraction as an Aid to Correction of Severe ScoliosisSurgical Technique
Jacob M. Buchowski, MD, MS1; David L. Skaggs, MD3; Paul D. Sponseller, MD2
1 Department of Orthopaedic Surgery, Washington University in St. Louis, 660 South Euclid Avenue, Campus Box 8233, St. Louis, MO 63110
3 Division of Orthopaedic Surgery, Childrens Hospital Los Angeles, 4650 Sunset Boulevard, #69, Los Angeles, CA 90027
2 c/o Elaine P. Henze, Medical Editor, BJ, ELS, Department of Orthopaedic Surgery, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, #A672, Baltimore, MD 21224-2780. E-mail address for E.P. Henze: ehenze1@jhmi.edu
View Disclosures and Other Information
The original scientific article in which the surgical technique was presented was published in JBJS Vol. 88-A, pp. 2035-41, September 2006
DISCLOSURE: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. One or more of the authors or a member of his or her immediate family received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from a commercial entity (Medtronics, Stryker Spine). Also, a commercial entity (Stryker Spine) paid or directed in any one year, or agreed to pay or direct, benefits in excess of $10,000 to a research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which one or more of the authors, or a member of his or her immediate family, is affiliated or associated.
Investigation performed at the Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, and the Division of Orthopaedic Surgery, Childrens Hospital Los Angeles, Los Angeles, California

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2007 Sep 01;89(2 suppl 2):297-309. doi: 10.2106/JBJS.G.00163
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Abstract

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 alternative.

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 follow-up.

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" (2006;88:2035-41).

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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