RF90#153
Rapid Fire
Early Outcomes on the Combined Halo-pelvic Traction and Kyphectomy from an All-posterior Approach for Severe Ky-photic Deformity
Patrick Leo F. Rebato, Mary Ruth A. Padua, MD FPOA FPSS, Gracia Cielo E. Balce, MD FPOA, Frederick Patrick I. Nicomedez, MD FPOA, FPSS, Samuel Arsenio M. Grozman, MD FPOA FPSS
University of the Philippines - Philippine General Hospital
Severe kyphotic deformity is one of the sequelae of tuberculosis of the spine. When left untreated, patients may develop restrictive lung and heart disease and even neurologic deficits. Surgical management of severe kyphotic deformity is complex and high risk especially in young children. Halo-pelvic traction is a technique reported to decrease complexity, blood loss, operative time and complication rate in definitive fixation, however, the technique has not been used locally in correction of severe deformities. This is a case report on a 6-year-old with severe kyphotic deformity secondary to tuberculosis of the spine. The aim is to provide novel insights into the design and application of the halo-pelvic traction construct, combined with an all-posterior surgical technique to achieve deformity correction. The halo-pelvic traction was able to achieve 26 degrees (35.13%) correction over 35 days with an average daily angular correction at 0.72 degrees per day and daily lengthening at 1.52mm per day. The patient was able to ambulate with assistance at 2 weeks and ambulate without assistance at 3 weeks on the traction construct. At 6 weeks, vertebral column resection and definitive fixation through an all-posterior approach was done with final angular correction of 49 deg (66.21%). Halo-pelvic construct was maintained as an adjunct to fixation and is to be maintained until with fusion The combined two-staged approach of halo-pelvic traction and vertebral column resection through an all-posterior approach has proven to be effective in this pediatric patient with severe kyphotic deformity.
