Management of severe rigid scoliosis by total awake correction utilizing differential distraction and in situ stabilization

Abstract

Severe rigid scoliotic curves pose a management challenge to the spine surgeon. The aim of surgery is to achieve acceptable deformity with minimal risk of complications. Posterior only vertebral column resection carries surgical morbidity and risk of neurological deterioration whereas anterior procedures are associated with cardiopulmonary complications. Halo traction has been proposed as an alternative to achieve slow gradual correction either before or after anterior or posterior release which is usually followed by a definitive corrective procedure and stabilization. In our case, we performed simultaneous anterior and posterior releases at the apex, stabilized with a temporary rod and then performed differential halo pelvic distraction to achieve the final correction. The spine is then stabilized without any further manipulation. Total awake correction of the deformity is possible utilizing differential distraction in a halo pelvic traction and temporary stabilizing rods. It can reduce the risk of neurological complications involved in intraoperative manipulation.

Keywords

• Severe scoliosis
• Deformity correction
• Total awake correction
• Differential distraction
• Halo correction