Posterior-only surgical correction with heavy halo-femoral traction for the treatment of severe and rigid congenital scoliosis associated with tethered spinal cord and Type II split cord malformation.

OBJECTIVE: To evaluate the safety and efficacy of posterior-only surgical correction with heavy halo-femoral traction for the treatment of severe and rigid congenital scoliosis (SRCS) associated with tethered spinal cord (TSC) and Type II split cord malformation (SCM). METHODS: 13 patients suffered from SRCS associated with TSC and Type II SCM underwent posterior-only surgical correction with heavy halo-femoral traction. The preoperative mean coronal Cobb angle was 88.87 degrees +/-12.15 degrees ; the mean flexibility was 15.28%+/-3.88%; the mean angle of thoracic kyphosis (TK) and lumbar lordosis (LL) were 39.63 degrees +/-18.47 degrees and 56.99 degrees +/-10.02 degrees , respectively. RESULTS: The mean duration of surgery was 320+/-43.64 min and the mean blood loss was 1422.31+/-457.59 ml. The mean follow-up period was 24.46+/-7.53 months. After heavy halo-femoral traction, the mean coronal Cobb angle was reduced to 59.14 degrees +/-8.75 degrees . After posterior-only surgical correction, postoperative mean coronal Cobb angle was further reduced to 33.85 degrees +/-8.77 degrees . The postoperative mean correction rate was 62.46%+/-5.04%. The postoperative mean angle of TK and LL were 29.31 degrees +/-6.75 degrees and 47.79 degrees +/-3.68 degrees , respectively. At the final follow up, the corrective loss rate of Cobb angle was only 0.69%. There were no significant differences between final follow-up and preoperative Modified Japanese Orthopaedic Association (mJOA) total scores. The Scoliosis Research Society (SRS)-22 total score improved at the final follow-up evaluation compared with the preoperative total score. CONCLUSIONS: Without prophylactic neurosurgical intervention and spine-shortening osteotomy, posterior-only surgical correction with heavy halo-femoral traction could be safe and effective for the treatment of SRCS associated with TSC and Type II SCM.