Surgical Strategies of Staged Spinal Traction–Fusion for Severe Scoliosis in Osteogenesis Imperfecta Type IV: A Case Report and Literature Review

<sec><title>Background</title> To describe a staged surgical protocol combining halo-pelvic traction (HPT) and posterior spinal fusion (PSF) for severe scoliosis in a patient with osteogenesis imperfecta (OI) type IV and to evaluate its outcomes. Given the paucity of population-level data on spinal orthoses in OI, this report highlights a tailored surgical approach for this high-risk population. </sec><sec><title>Case Presentation and Management</title> A 16-year-old girl with OI type IV and progressive scoliosis underwent a 2-stage correction: (1) preoperative HPT for 3 months to reduce coronal deformity and optimize spinal alignment, followed by (2) PSF with all-pedicle-screw instrumentation. The staged protocol achieved successful deformity correction without neurological or implant-related complications. All pedicle screws were safely placed despite osteopenic bone. At follow-up, radiographic outcomes were maintained, and the patient reported improved posture and function. Minor surgical differences and literature review are highlighted for multimodal management. </sec><sec><title>Conclusion</title> Progressive scoliosis in patients with OI can be effectively managed through structured, phased therapeutic programs, with the combined approach of HPT and PSF representing a significant surgical intervention strategy. </sec><sec><title>Clinical Relevance</title> The clinical significance of this approach lies in transforming the management of a challenging rare disease—progressive scoliosis in osteogenesis imperfecta—from an empirical endeavor into a structured, systematic clinical pathway, while providing a validated technical combination for its most critical surgical intervention. </sec><sec><title>Level of Evidence</title> 5. </sec>