Skull-femoral traction and vertebral osteotomies for severe rigid scoliosis with trunk imbalance

This study aimed to explore skull-femoral traction and posterior vertebral column resection (PVCR) for the treatment of severe rigid scoliosis with trunk imbalance. The study also aimed to compare the procedure to the non-traction procedure with matched analysis. From January 2007 to December 2021, 59 patients (traction group) with severe rigid scoliosis and trunk imbalance underwent skull-femoral traction and PVCR. For comparison, another 1:1 matched group of 59 patients (non-traction group) was also retrospectively reviewed. These patients were treated with PVCR alone. The spinal function was assessed using the Scoliosis Research Society-Questionnaire. Differences were considered statistically significant at P < .05. The age of the traction and non-traction groups were 21.1 ± 8.2 years and 21.4 ± 10.3 years, respectively (P > .05). The duration of skull-femoral traction was 24 days (range, 14-39 days). The operative time was 521 ± 101 and 679 ± 443 minutes, respectively (P < .05). The amount of intraoperative blood loss was 987 ± 446 and 5961 ± 3214 mL, respectively (P < .05). The number of resected vertebrae was 0.4 ± 0.3 vs 1.1 ± 0.6 (P < .05). The groups were followed up for 34.9 ± 7.3 months and 31.1 ± 6.6 months, respectively (P > .05). The total Scoliosis Research Society-22 Questionnaire Scores were 4.7 (range, 3.8-5) and 4.5 (range, 3.3-5), respectively (P > .05). In the treatment of severe rigid scoliosis with trunk imbalance, preoperative skull-femoral traction improves curve flexibility of the spine, decreasing osteotomy grade, PVCR, average number of 3-column vertebrae resection, operative time, and intraoperative blood loss. However, both traction and non-traction techniques achieve similar spine correction and functional outcomes with similar complications and modalities.