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Purpose <p>Despite advancements in surgical techniques, surgical correction of scoliosis remains a challenge. Several adjunct measures to potentially reduce curve magnitude and increase flexibility intraoperatively have been described. To address some of the deficiencies associated with these techniques, we have developed an alternative technique in our institution. We describe the use of an outrigger distractor to apply an intraoperative costo-pelvic distraction force to the concave side of the major curve in scoliosis. We also aim to review the outcomes of all scoliosis patients who were treated with intraoperative costo-pelvic distraction in our institution.</p> Methods <p>A longitudinal cohort series of patients in whom costo-pelvic distraction was utilised during scoliosis correction surgery was identified from a prospectively maintained database. All cases had a minimum of 2 years follow-up. All surgeries were performed in the same institution by one of the two senior authors, between January 2012 and January 2019. Statistical analysis was performed using data analysis software STATA Version 16.0 (StataCorp, College Station, TX).</p> Results <p>25 patients were included in final analysis, 16 of whom were female and 10 of whom were male. Diagnoses included neuromuscular early onset scoliosis (EOS) (<i>n</i> = 10), idiopathic EOS (<i>n</i> = 4), syndromic EOS (<i>n</i> = 4), congenital EOS (<i>n</i> = 1), and adolescent idiopathic scoliosis (<i>n</i> = 6). Follow-up period ranged from 24 to 109 months, with a median of 40&#xa0;months (interquartile range: 30–48&#xa0;months). Median hospital stay was 7&#xa0;days (interquartile range: 6–8&#xa0;days). The mean age at time of surgery was 9.9&#xa0;years (SD ± 3.7). 15 patients had the technique employed during insertion of growing rods; the remaining 10 patients utilised the technique during definitive spinal fusion.&#xa0;Intraoperative imaging demonstrated a mean correction of 57.4% (SD ± 8.4%) was obtained with the distractor in place, before instrumentation of the spine. Postoperatively, the average major curve was 26.5° (SD ± 12.2°); the mean correction rate was 67.5% (SD ± 14.2%). The insertion of growing rods cohort had a similar rate of correction compared to the definitive posterior spinal fusion cohort (66.2% vs 69.4%, <i>p</i> = 0.59). A strong positive correlation existed between the absolute change in major angle achieved by costo-pelvic distraction and the final absolute change in major angle (<i>r</i> = 0.87, <i>p</i> = 0.0001). There were no focal complications observed secondary to the use of costo-pelvic distraction.</p> Conclusion <p>An outrigger distractor applying an intraoperative costo-pelvic distraction force was employed during scoliosis correction surgery at our institution. It was found to achieve favourable outcomes in terms of partial on-table correction for scoliosis with minimal complications. We would encourage all surgeons involved in the correction of spinal deformity to consider implementing the technique as it may offer a cost-effective and simple solution to some of the challenges faced when instrumenting major curves.</p>

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A temporary costo-pelvic distractor for intraoperative spinal deformity reduction in the treatment of severe scoliosis

  • 期刊论文

  • 发表日期：

    2025年10月17日

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  • Ben Murphy,
  • Matthew J. Nagle,
  • Hussam Elkhwad,
  • Gerard A. Sheridan,
  • Nuala McAuley,
  • Jacques Noel,
  • Patrick J. Kiely

摘要

Purpose

Despite advancements in surgical techniques, surgical correction of scoliosis remains a challenge. Several adjunct measures to potentially reduce curve magnitude and increase flexibility intraoperatively have been described. To address some of the deficiencies associated with these techniques, we have developed an alternative technique in our institution. We describe the use of an outrigger distractor to apply an intraoperative costo-pelvic distraction force to the concave side of the major curve in scoliosis. We also aim to review the outcomes of all scoliosis patients who were treated with intraoperative costo-pelvic distraction in our institution.

Methods

A longitudinal cohort series of patients in whom costo-pelvic distraction was utilised during scoliosis correction surgery was identified from a prospectively maintained database. All cases had a minimum of 2 years follow-up. All surgeries were performed in the same institution by one of the two senior authors, between January 2012 and January 2019. Statistical analysis was performed using data analysis software STATA Version 16.0 (StataCorp, College Station, TX).

Results

25 patients were included in final analysis, 16 of whom were female and 10 of whom were male. Diagnoses included neuromuscular early onset scoliosis (EOS) (n = 10), idiopathic EOS (n = 4), syndromic EOS (n = 4), congenital EOS (n = 1), and adolescent idiopathic scoliosis (n = 6). Follow-up period ranged from 24 to 109 months, with a median of 40 months (interquartile range: 30–48 months). Median hospital stay was 7 days (interquartile range: 6–8 days). The mean age at time of surgery was 9.9 years (SD ± 3.7). 15 patients had the technique employed during insertion of growing rods; the remaining 10 patients utilised the technique during definitive spinal fusion. Intraoperative imaging demonstrated a mean correction of 57.4% (SD ± 8.4%) was obtained with the distractor in place, before instrumentation of the spine. Postoperatively, the average major curve was 26.5° (SD ± 12.2°); the mean correction rate was 67.5% (SD ± 14.2%). The insertion of growing rods cohort had a similar rate of correction compared to the definitive posterior spinal fusion cohort (66.2% vs 69.4%, p = 0.59). A strong positive correlation existed between the absolute change in major angle achieved by costo-pelvic distraction and the final absolute change in major angle (r = 0.87, p = 0.0001). There were no focal complications observed secondary to the use of costo-pelvic distraction.

Conclusion

An outrigger distractor applying an intraoperative costo-pelvic distraction force was employed during scoliosis correction surgery at our institution. It was found to achieve favourable outcomes in terms of partial on-table correction for scoliosis with minimal complications. We would encourage all surgeons involved in the correction of spinal deformity to consider implementing the technique as it may offer a cost-effective and simple solution to some of the challenges faced when instrumenting major curves.