Two-stage Modified Halo Pelvic Distraction In Treatment Of Severe Scoliosis

Purpose: To carry on an improvement design to the classic Halo pelvic frame,resolve the problem of the complication of nerve injury which the classic Halo pelvic frame easy to encounter. To evaluate the clinical curative effect in the treatment of the severe scoliosis by the modified Halo pelvic frame. To evaluate the clinical curative effect in the treatment of the severe scoliosis by the two-stage modified Halo pelvic distraction in combination with two-stage anterior release and posterior correction.Method: This research was divided into two parts. In the first part, 10 patients had two-stage modified Halo pelvic distraction for treatment of the severe scoliosis. We retrospectively reviewed the records of the patients. The amount of correction was determined by measuring the change of body height and the Cobb′s angles of scoliosis and kyphosis on radiographs after each stage distraction. In the second part, We retrospectively reviewed the records of the 10 patients in whom severe scoliosis had been treated with two-stage modified Halo pelvic distraction in combination with two stage anterior release and posterior correction. The amount of correction was determined by measuring the change of body height, trunk shift, shoulder height difference and the Cobb′s angles of scoliosis and kyphosis on radiographs at the preoperative, postoperative and final follow-up.There were 3 males and 7 females with an average age of 16.8 years ( from 13 to 24 years), 4 cases were congenital scoliosis and 6 cases were idiopathic scoliosis, the average Cobb′s angle of scoliosis was 91.8°(68°-115°) and the average Cobb′s angle of kyphosis was 69.5°(48°-86°) with the mean 12.1% correction in bending film.Results: All the patients had been treated with temporary internal distraction before anterior release for 8 - 18 days with an average of 13 days. After the first distraction, the average Cobb′s angle of scoliosis and kyphosis were 63.5°(49°-75°) with the mean 30.4% correction and 69.5°(48°-86°) with the mean 22.3% correction respectively. After the second distraction, the average Cobb′s angle of scoliosis was 46.5°(38°-56°) and the average Cobb′s angle of kyphosis was 43.3°(25°-55°) with the mean 30.4% correction and 22.3% correction respectively. The average body height had increased 5.16cm.All the patients were followed up for 4- 15 months with an average of 9.5 months. The average body height had increased 6.46cm after operation, the trunk shift had corrected from 26.5mm(13mm-53mm)to 5.9mm(0mm-13mm), the shoulder height difference had corrected from 21.6mm(10mm-45mm)to 5.3mm(0mm-16mm), the Cobb′s angles of scoliosis and Kyphosis had corrected to 30.8°(16°-45°) and 31.6°(20°-46°) with the mean 66.5%(54.1%-76.5%)correction and 55.1%(44.0%-63.2%)correction respectively.Conclusion: The modified Halo pelvic distraction is an effective treatment of distraction for severe scoliosis with few and slight complications. Two-stage modified Halo pelvic distraction in combination with two-stage anterior release and posterior correction for treatment of severe scoliosis is an effective treatment for severe scoliosis, avoid the occurrence of complications of nerve injury in the greatest extent possible.