Muhammad Saad Ilyas, Abdullah Shah, Uruj Zehra, Muhammad Ismail, Haseeb Elahi, Amer Aziz
{"title":"Effectiveness and safety of preoperative distraction using modified halo-pelvic Ilizarov distraction assembly in patients with severe kyphoscoliosis.","authors":"Muhammad Saad Ilyas, Abdullah Shah, Uruj Zehra, Muhammad Ismail, Haseeb Elahi, Amer Aziz","doi":"10.31616/asj.2024.0104","DOIUrl":null,"url":null,"abstract":"<p><strong>Study design: </strong>A 2-year follow-up study.</p><p><strong>Purpose: </strong>To evaluate the effectiveness of modified halo-pelvic Ilizarov distraction assembly in the management of patients with severe kyphoscoliosis.</p><p><strong>Overview of literature: </strong>Severe and rigid scoliosis curves are always a challenge for operating surgeons. Preoperative correction through halo-pelvic devices successfully minimizes the severity of the curve; however, cumbersome complications are also reported with its use. Modified assembly could be safe for these cases.</p><p><strong>Methods: </strong>Patients with severe kyphoscoliosis having coronal Cobb angle >90° were applied with modified halo-pelvic Ilizarov distraction assembly preoperatively. The modified assembly consisted of a pelvic component and halo ring, and distraction was given at the rate of 2-3 mm/day for 6-12 weeks. Complete clinical assessments along with pulmonary function tests were performed, and scoliosis series X-ray images were assessed for coronal and sagittal Cobb angle and other spinopelvic parameters before applying the assembly and during 2 years of follow-up.</p><p><strong>Results: </strong>Thirty-four patients (age, 9-27 years; male/female ratio of 18:16) were included. The coronal and sagittal Cobb angles were 116°±16.2° and 84°±28.3°, respectively. Correction rates obtained through modified halo-pelvic assembly were nearly 52% (p=0.001) in coronal and 40% (p=0.001) in sagittal Cobb angles, with improvement in height (p=0.001). Apical vertebral translation and coronal balance were also improved significantly (p=0.001). Further improvements in all the parameters were obtained after definitive surgery, with improvements in the forced expiratory volume in 1 second (p =0.002) and forced vital capacity (p=0.001).</p><p><strong>Conclusions: </strong>Our modified halo-pelvic Ilizarov distraction assembly can achieve good correction in severe spinal deformities without significant risk to neurology, has fewer complications, and promotes good patient compliance.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":null,"pages":null},"PeriodicalIF":2.3000,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11366560/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Asian Spine Journal","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.31616/asj.2024.0104","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/8/9 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
Abstract
Study design: A 2-year follow-up study.
Purpose: To evaluate the effectiveness of modified halo-pelvic Ilizarov distraction assembly in the management of patients with severe kyphoscoliosis.
Overview of literature: Severe and rigid scoliosis curves are always a challenge for operating surgeons. Preoperative correction through halo-pelvic devices successfully minimizes the severity of the curve; however, cumbersome complications are also reported with its use. Modified assembly could be safe for these cases.
Methods: Patients with severe kyphoscoliosis having coronal Cobb angle >90° were applied with modified halo-pelvic Ilizarov distraction assembly preoperatively. The modified assembly consisted of a pelvic component and halo ring, and distraction was given at the rate of 2-3 mm/day for 6-12 weeks. Complete clinical assessments along with pulmonary function tests were performed, and scoliosis series X-ray images were assessed for coronal and sagittal Cobb angle and other spinopelvic parameters before applying the assembly and during 2 years of follow-up.
Results: Thirty-four patients (age, 9-27 years; male/female ratio of 18:16) were included. The coronal and sagittal Cobb angles were 116°±16.2° and 84°±28.3°, respectively. Correction rates obtained through modified halo-pelvic assembly were nearly 52% (p=0.001) in coronal and 40% (p=0.001) in sagittal Cobb angles, with improvement in height (p=0.001). Apical vertebral translation and coronal balance were also improved significantly (p=0.001). Further improvements in all the parameters were obtained after definitive surgery, with improvements in the forced expiratory volume in 1 second (p =0.002) and forced vital capacity (p=0.001).
Conclusions: Our modified halo-pelvic Ilizarov distraction assembly can achieve good correction in severe spinal deformities without significant risk to neurology, has fewer complications, and promotes good patient compliance.