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- Title
Comparative Analysis of Static and Dynamic Intraoperative Skull-Femoral Traction (Iosft) in Adolescent Idiopathic Scoliosis (AIS) Correction.
- Authors
Ghag, Ravi; Tang, Yale; Desai, Sameer; Reilly, Christopher; Miyanji, Firoz
- Abstract
Introduction: Limited literature exists comparing outcomes in AIS correction with intraoperative skull-femoral traction (IOSFT), however, current findings suggest it to be an effective, safe, and well-tolerated adjunctive technique for improving outcomes and reducing healthcare resource use in curves > 80º. Furthermore, previous studies highlight the utility of IOSFT for large and rigid deformities, yet it is becoming increasing popular for use on smaller curves. Various IOSFT techniques exist, but to date no studies have compared the safety and efficacy of different IOSFT methods. The aim of this study is to compare the intra- and post-operative neurologic safety and clinical efficacy of static IOSFT, which places a fixed traction force, and dynamic IOSFT, which entails hanging weight from bilateral femora. Material and Methods: A retrospective comparative case series was conducted. Static IOSFT is applied with a fixed traction force, whereas 96 consecutive surgical patients treated by two surgeons at a tertiary care facility with mean 1.6 year follow-up between 2011 and 2014 were identified. 63 patients received static and 33 patients received dynamic IOSFT. Each surgeon employed only one mode of traction. Primary outcomes included neuromonitoring (NM) changes, estimated blood loss (EBL), OR time, length of stay (LOS), percent curve correction, and complications. Descriptive statistics, t-tests and Fisher's exact test for significance (α = 0.05) were calculated for analysis. Results: We found comparable safety and efficacy between the two common methods of traction; dynamic IOSFT, and static IOSFT. Demographic variables and curve characteristics were similar between static and dynamic groups. Levels fused (12.3 static vs. 12.1 dynamic), EBL (601 mL static vs. 508 mL dynamic), OR time (365 min static vs. 376 min dynamic), LOS (6 days static vs. 5.8 days dynamic), and curve correction (71.5% static vs. 69.5% dynamic) were not significantly different. Mean traction weight applied in the dynamic group was 12.1 lbs to the head and 23.3 lbs to bilateral legs. NM changes were not significantly different: 11 (17.5%) patients in the static group and 4 (12.1%) patients in the dynamic group. Specifically, MEP and SSEP changes occurred in 11 (17.5%) and 2 (3.2%) patients in the static group and 3 (9.1%) and 1 (3%) patient in the dynamic group. Mean number of osteotomies was significantly higher in the static group (p < 0.001). No significant differences in mean follow-up major cobb angle (18.4º static vs. 20.3º dynamic), mean percent correction (71.5% static vs. 69.5% dynamic), or complication rates between the groups were observed. Conclusion: IOSFT in AIS correction is a safe and effective adjunctive technique in curves < 80°, with no neurologic complications in this cohort and similar rates of NM changes regardless of static or dynamic application. Perioperative clinical outcomes and postoperative radiographic outcomes were comparable between dynamic and static IOSFT. Further research is required to quantify safe amounts of IOSFT.
- Publication
Global Spine Journal, 2018, Vol 8, p119S
- ISSN
2192-5682
- Publication type
Article
- DOI
10.1177/2192568218771030