Introduction and purpose of study: Different surgical techniques are available for treating rigid kyphoscoliosis. Halo traction, either used with gravity or anchored to the pelvis, are well established methods to achieve gradual pre-operative traction to optimize correction before the definitive fusion surgery. This technique may be supplemented with multi-level facetectomies and osteotomies ranging from multi- Ponte osteotomies to vertebral column resection. On the other hand, temporary internal distraction is another option that avoids the complications related to halo traction and may preclude the utilization of morbid vertebral column resections. This is a case of an early onset scoliosis presenting late with severe rigid kyphoscoliosis. He was treated with temporary internal distraction without the need for vertebral column resection. (Table 1)

Methodology: This is a 17-year-old boy who had early onset scoliosis and started bracing at 9-years-old. He was lost to follow-up. Upon initial presentation 6 years later, the kyphoscoliosis was measured at 117 degrees and progressed to 132 degrees after another 11 months. Temporary internal distraction technique was utilized to aid in curve correction.

Results: Total operative time was 16 hours and 47 minutes. Blood loss was 2.5 liters. An intra-operative fracture on the 6th rib which was used as 1 of 2 proximal anchors during distraction of the concave side occurred. No pulmonary complications nor post-operative infection was noted. Total hospital stay was 13 days; 3 days were spent at the pediatric ICU for close post-operative monitoring. Repeat radiograph 2 months post-operatively showed kyphosis to be at 61 degrees (from CT Cobb’s angle of 132 degrees) 53% correction.

Conclusion: In this case report, temporary internal distraction has demonstrated to be a safe and reliable adjunct to reduction and re-alignment of rigid kyphoscoliosis.