Staged Halo-Pelvic Traction Combined With Posterior Spinal Fusion versus One-Stage Surgery for Severe Rigid Spine Deformity Requiring Three-Column Osteotomy: A Comparative Study

Study designA retrospective cohort study.ObjectiveSevere rigid spine deformity presents major challenges in surgical correction. Although three-column osteotomies (3-CO) provide powerful correction, they are associated with prolonged operative time, increased blood loss, and high neurological risk. This study aimed to compare the radiographic correction, surgical parameters, and complication profiles between staged halo-pelvic traction combined with posterior spinal fusion (HPT+PSF) and one-stage posterior spinal fusion (PSF) in patients with severe rigid spine deformity requiring 3-CO.MethodsThis retrospective cohort study included 110 patients (mean age, 25.7 ± 8.5 years) with severe rigid deformity (Cobb angle or maximal kyphosis >90°, flexibility <30%) who underwent either staged HPT+PSF (n = 60) or single-stage PSF (n = 50) between 2016 and 2023. Radiographic parameters, including the main curve Cobb angle and maximal kyphosis (MK), were measured preoperatively, post-traction, postoperatively, and at the latest follow-up. Operative time (ORT), estimated blood loss (EBL), osteotomy grade, intraoperative neuromonitoring (IONM) alerts, and complications were compared between groups. Pulmonary function tests (PFTs) were evaluated longitudinally.ResultsFollowing traction, the main curve Cobb angle and MK in the HPT+PSF group improved from 132.4° ± 23.3° to 65.1° ± 20.7° and from 122.3° ± 29.7° to 53.3° ± 24.1°, respectively. At the last follow-up, the correction rate of the main curve and MK were significantly higher in the HPT+PSF group than in the PSF group (62.9% vs 55.2%, <i>P</i> = 0.004; 67.7% vs 54.5%, <i>P</i> < 0.001). The HPT+PSF group demonstrated significantly reduced ORT (298.3 ± 64.7 vs 361.9 ± 76.3 min, <i>P</i> < 0.001) and EBL (490.5 ± 183.3 vs 1010.6 ± 252.1 mL, <i>P</i> < 0.001). The rate of IONM alerts (3.3% vs 20.0%, <i>P</i> = 0.005) and neurological deficits (3.3% vs 14.0%, <i>P</i> = 0.042) were markedly lower in the HPT+PSF group. Although traction-related complications occurred in 16.7% of patients, all were transient and resolved after adjustment of HPT devices.ConclusionStaged HPT followed by PSF provides a safe and effective strategy for the management of severe rigid spine deformities. In terms of radiographic correction and perioperative safety profile, this staged approach demonstrated significant advantages over one-stage 3-CO, notably reducing operative time, blood loss, and neurological risks. Preoperative traction effectively decreases deformity stiffness and magnitude, facilitating safer and less invasive surgical correction.