Early Outcomes of Staged Combined Halo-Pelvic Traction and All-Posterior Kyphectomy for Severe Kyphotic Deformity
Main Article Content
Abstract
Severe kyphotic deformity is one of the sequelae of tuberculosis of the spine. When left untreated, patients may develop restrictive lung and heart disease and even neurologic deficits. Surgery is complex and risky, especially in young children. Halo-pelvic traction is a technique reported to decrease complexity, blood loss, operative times, and complication rates of definitive fixation of severe deformities; however, the technique has not been used locally.
This is a case report on a 6-year-old with severe kyphotic deformity secondary to tuberculosis of the spine. The aim was to provide novel insights into the design and application of the halo-pelvic traction construct, combined with an all-posterior surgical technique to achieve deformity correction.
The halo-pelvic traction was able to achieve 26 degrees (35.13%) correction over 35 days with an average daily angular correction of 0.72 degrees per day and daily lengthening at 1.52 mm per day. The patient was able to ambulate with assistance at two weeks and ambulate without assistance at three weeks on the traction construct. At six weeks, vertebral column resection and definitive fixation through an all-posterior approach were done with final angular correction of 49 deg (66.21%). The halo-pelvic construct was maintained as an adjunct to fixation and will be maintained until fusion.
The combined two-staged approach of halo-pelvic traction and vertebral column resection through an all-posterior approach has proven to be effective in this pediatric patient with severe kyphotic deformity.
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