Intraoperative traction does not improve curve correction or pelvic obliquity within a matched cohort of patients with neuromuscular scoliosis.

Abstract

Evaluate the utility of intraoperative traction (IOT) during posterior spinal fusion (PSF) in a matched cohort at a high-volume neuromuscular scoliosis (NMS) center. A nested case-control study was performed on a single-center retrospective database of NMS patients. Those diagnosed with cerebral palsy were pair-matched by age (± 1 year), preoperative curve magnitude (± 10°), preoperative traction curve magnitude (± 10°), and flexibility index (± 5%). Paired t tests or Wilcoxon signed-rank tests were used to analyze continuous variables between groups. Fisher's Exact tests were used to compare categorical variables by group. Thirty-one unique case-control matches were identified (n = 62). IOT and non-IOT groups were similar in terms of EBL 855 (IQR 500-1200) vs. 800 (IQR 650-1350) cc (p = 0.60), length of ICU stay 1.7 (IQR 1.0-2.7) vs. 2.3 (IQR 1.7-3.1) days (p = 0.14), BMI 18.0 (IQR 14-20) vs. 15.5 (IQR 14-18) (p = 0.10), sex distribution 54.8% vs. 51.6% (p > 0.99), and changes in neuromonitoring signals 4/31 (13%) vs. 3/31 (10%) (p > 0.99). Complication rate was 22.6% (7/31) for IOT and 25.8% (8/31) for non-IOT (p > 0.999). There were no statistical differences in surgical time 414 ± 131 vs. 397 ± 133 min (p = 0.64) or anesthesia time 551 ± 136 vs. 529 ± 135 min (p = 0.56). Both groups had similar postoperative curve magnitude IOT = 37° vs. non-IOT = 42° (p = 0.28) and percent curve correction IOT = 60% vs. non-IOT = 56% (p = 0.30). Percent correction of pelvic obliquity was also similar 78% (IQR 67-90) vs. 68% (IQR 60-91) (p = 0.18) between groups. There was no difference in postoperative curve correction or pelvic obliquity between those treated with IOT versus those without during PSF. III.