Evaluation of Pulmonary Function After Halo-Pelvic Traction for Severe and Rigid Kyphoscoliosis Utilizing CT with 3D Reconstruction

JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME(2023)

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Abstract
Background: The purpose of the present study was to evaluate changes in pulmonary function, caused by preoperative halo-pelvic traction (HPT) for the treatment of extremely severe and rigid kyphoscoliosis, with use of 3-dimensional computed tomography (3D-CT) reconstruction and pulmonary function tests (PFTs).Methods: Twenty-eight patients with severe and rigid scoliosis (Cobb angle, >100 degrees) underwent preoperative HPT and staged posterior spinal fusion. CT, radiographic assessment, and PFT were performed during pre-traction and post-traction visits. The changes in total lung volume were evaluated with use of 3D-CT reconstruction, and the changes in pulmonary function were evaluated with PFTs at each time point. Differences were analyzed with use of 2-tailed paired Student t tests, and correlations were analyzed with use of Spearman rank tests.Results: None of the patients had pulmonary complications during traction, and all radiographic spinal measurements improved significantly after HPT. The main Cobb angle was corrected from 143.30 degrees +/- 20.85 degrees to 62.97 degrees +/- 10.83 degrees between the pre-traction and post-traction evaluations. Additionally, the C7-S1 distance was lengthened from 280.48 +/- 39.99 to 421.26 +/- 32.08 mm between the pre-traction and post-traction evaluations. Furthermore, 3D lung reconstruction demonstrated a notable increase in total lung volume (TLV) (from 1.30 +/- 0.25 to 1.83 +/- 0.37 L) and maximum lung height (from 176.96 +/- 27.44 to 202.31 +/- 32.45 mm) between the pre-traction and post-traction evaluations. Moreover, PFTs showed that total lung capacity (TLC) improved between the pre-traction and post-traction evaluations (from 2.06 +/- 0.32 to 2.98 +/- 0.82 L) and that the changes in T1-T12 distance and maximum lung height were correlated with changes in TLV (p = 0.0288 and p = 0.0007, respectively).Conclusions: The application of HPT is a safe and effective method for improving pulmonary function in patients with extremely severe and rigid scoliosis before fusion surgery. The TLV as measured with CT-based reconstruction was greatly increased after HPT, mainly because of the changes in thoracic height.
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Key words
rigid kyphoscoliosis,pulmonary function,halo-pelvic
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