The role of traction in the treatment of severe idiopathic scoliosis: non-traction vs. traction

Treatment planning for severe idiopathic scoliosis (SIS) requires consideration of both deformity correction and the appropriate grade of osteotomy. This study aimed to compare radiographic and clinical outcomes between patients who underwent surgical correction with or without preoperative skull-femoral traction. We retrospectively reviewed patients with SIS who had a main thoracic curve greater than 90°and flexibility less than 30% and underwent surgery at our institution between 2014 and 2018. Patients were grouped according to whether they received preoperative skull-femoral traction (SFT). The two groups were compared in terms of age at surgery, body mass index, preoperative and postoperative radiographic parameters (main scoliosis, kyphosis and their flexibilities, deformity angular ratios, CSVL-C7PL, SVA, etc.), SRS-Schwab osteotomy grade, operative time, blood loss, complications, and 3-year follow-up outcomes. Twenty-two SIS cases were involved (traction vs. non-traction: 12 cases vs. 10 cases). There were no significant differences in age at surgery or in most preoperative radiographic parameters, except for CSVL-C7PL (4.1 cm vs. 1.7 cm, P < 0.05). Compared with the non-traction group, the traction group had a significantly lower mean SRS-Schwab osteotomy grade (2.8 vs. 4.8, P < 0.01), along with shorter operative time, less blood loss, and fewer complications. The final corrective effects of the two groups were similar at 3-year follow-up ( P > 0.05 ). Preoperative skull-femoral traction may help balance deformity correction and surgical invasiveness in SIS by reducing the need for higher-grade osteotomy, operative burden, and complications while maintaining comparable correction outcomes.