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KMID : 1145220200170020461
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Neurospine
2020 Volume.17 No. 2 p.461 ~ p.465
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Neurologic Deficit During Halo-Gravity Traction in the Treatment of Severe Thoracic Kyphoscoliotic Spinal Deformity
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Pham Martin H.
Cerpa Meghan
Makhni Melvin C.
Sielatycki John Alexander
Lenke Lawrence G.
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Abstract
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Correction of severe spinal deformity is a significant challenge for spinal surgeons. Although halo-gravity traction (HGT) has been shown to be well-tolerated and safe, we report here a case of neurologic decline during treatment. A 24-year-old male presents with severe thoracic kyphoscoliosis with > 180° of 3-dimensional deformity. Magnetic resonance imaging showed his thoracic spinal cord draped across his T7?9 apex. His neurologic exam showed lower extremity myelopathy. During week 7 at a goal traction weight of 18.1 kg, his distal lower extremity exam declined from 4+/5 to 2/5. His traction weight was lowered to 11.3 kg. He subsequently sustained a ground-level fall and became paraparetic with a motor exam of 1?2/5. He subsequently underwent a T1?L4 posterior spinal instrumentation and fusion with a T7?9 vertebral column resection. Postoperatively, he was noted to have a complete return to his baseline neurologic exam. At his 4-month postoperative visit, he was now full strength in his lower extremities with complete resolution of his myelopathy. We present here a case of neurologic decline in a patient with severe kyphoscoliosis who underwent HGT and discuss the management decisions associated with this challenging scenario.
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KEYWORD
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pinal deformity, Halo-gravity traction, Neurologic deficit, Complications, Kyphoscoliosis
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