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Thread: traction during surgery

  1. #1
    Join Date
    Jan 2007
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    Ontario, Canada
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    140

    traction during surgery

    I'm just curious as to how many people have traction during surgery.

    My son had his surgery just recently (May 16) and was fused from T4 to L1.
    I knew he would be put in traction during his surgery and the surgeon assured me it was very safe. I didn't ask any more about the procedure more because I didn't really care to know the details. I was however very surprised after the surgery to see four bandages just above his knees on the inside and outside of each leg. Apparently as part of the traction they put a pin or screw through the femur (leg bone) and also screw into the skull. He never had any pain afterwards from this, I just found it quite remarkable that this was how they do traction.
    Also he had quite a large ribhump and the surgeon said beforehand he didn't need to cut any ribs in order to get rid of it. I questioned him repeatedly on this and it was true, he didn't cut any ribs and his rib hump is not perfect but dramatically less. He also had a really good correction, from close to T80 to mid 20ish and this was after his bending xrays suggested he was very stiff.

    I never see anyone talking about traction during surgery. Is this common or uncommon?
    And have others more or less lost their ribhumps without doing a thoroscopy?
    mom of Patrick, age 15 at time of surgery
    diagnosed July 2006 curves T58 L 38

    Nov. 2006 curves T72 L38
    also lordoscoliosis

    feb.2007 curves T79 L43

    Surgery May 16 2007
    fused T4 to L1

  2. #2
    Join Date
    Nov 2005
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    404
    Hi :-)

    Rib deformities can often be greatly reduced during spinal fusion surgery as the procedure involves de-rotating the vertebrae that the ribs are attached to, so the ribs are pulled back into place.

    If a patient's curve has been there for a long time and has a lot of rotation, the ribss usually grow deformed in their own right, curved around the curve of the spine, and it won't be possible to correct the rib hump by untwisting the vertebrae. In these cases, a thorocoplasty is the answer.

    As for halo traction (which is what your son will have had)....I haven't heard of this being used solely during surgery, but it makes sense. It's the most stable way of applying traction to a person's body to pull out the curves.

    I had halo-tibial traction applied after my anterior release when I was 10 back in 1986, and I was in this traction for the next few weeks, during which time I had my posterior fusion. These days though, they prefer to use halo-gravity traction for people who need traction over a period of time.

    Hope this helps!

  3. #3
    Join Date
    Jun 2006
    Location
    Euharlee, Georgia
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    449
    When I had my surgery back in the 70s, I was in traction for a week before surgery. After surgery when I was in my body cast for 9 months, I was in traction in there. Things have changed a lot! My daughter did not have any traction with her surgery 3 years ago.
    T12- L5 fusion 1975 - Rochester, NY
    2002 removal of bottom of rod and extra fusion
    3/1/11 C5-C6 disc replacement
    Daughter - T7 - L3 fusion 2004

  4. #4
    Join Date
    Mar 2008
    Posts
    9

    traction during surgery

    My son's doctor has mentioned traction during scoliosis surgery to improve the correction. I found this thread and by chance have had previous contact with the initiator of the thread. I wanted to bring it up again and see if anyone can add information for me.

    To recap, my son is 15yo with a 60* thoracic curve and we are asking questions before we head for surgery. His spine was identified as being stiff but that point was not elaborated on yet. However traction was mentioned as a protocol that our hospital surgeons routinely/often use to improve correction.

    Has anyone else heard of traction during surgery or actually had it performed? My son's doctor is in Toronto but trained in St Louis. Has anyone in St Louis got more info they can pass on?

    Appreciate the info,
    flowergardenj

  5. #5
    Join Date
    Sep 2003
    Location
    Northern California
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    6,336
    Hi...

    Here's an abstract of a study that might be helpful:

    http://www.ncbi.nlm.nih.gov/pubmed/15502568

    Effectiveness of spinal release and halo-femoral traction in the management of severe spinal deformity.
    Mehlman CT, Al-Sayyad MJ, Crawford AH.

    Division of Pediatric Orthopaedics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229-3039, USA. ctmehlman@post.harvard.edu

    The purpose of this retrospective review was to assess the effectiveness of spinal release and halo-femoral traction in the management of severe spinal deformity. Twenty-four patients had halo-femoral traction and a spinal release. Analysis focused on pre-traction curve, preoperative curve in bending or hyperextension films, final traction curve, traction weight as a percent of body weight, and complications associated with traction. The average pre-traction curve was 95 degrees and the average pre-traction curve in bending was 73 degrees; the final traction average curve was 44 degrees. The difference between the magnitude of curve correction in bending and traction films was statistically significant. Traction weight was increased to an average of 54% of body weight. The only complication was a bilateral lower extremity sensory deficit that resolved after traction weight reduction. The average final correction was 71%. Spinal release and halo-femoral traction offer a safe approach to the correction of severe spinal deformities before fusion.

  6. #6
    Join Date
    Mar 2008
    Posts
    9
    Hi LindaRacine

    I reviewed this reference (Effectiveness of spinal release and halo-femoral traction in the management of severe spinal deformity.
    Mehlman CT, Al-Sayyad MJ, Crawford AH.) and found that it was about traction prior to surgery. What my son's doctor is talking about is traction during surgery, while the patient is on the operating table. Apparently there are pins in the head (halo) and in the leg above the knee and the body is under traction while the rods are put in place. The traction is not maintained after the surgery and did not occur prior to being on the table.

    flowergardenj

  7. #7
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    Sep 2003
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    Northern California
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    Quote Originally Posted by flowergardenj
    Hi LindaRacine

    I reviewed this reference (Effectiveness of spinal release and halo-femoral traction in the management of severe spinal deformity.
    Mehlman CT, Al-Sayyad MJ, Crawford AH.) and found that it was about traction prior to surgery. What my son's doctor is talking about is traction during surgery, while the patient is on the operating table. Apparently there are pins in the head (halo) and in the leg above the knee and the body is under traction while the rods are put in place. The traction is not maintained after the surgery and did not occur prior to being on the table.

    flowergardenj
    I'm not sure that's correct. I'm thinking that the author might be referring to traction in surgery, before placing the fusion material, when he uses the term "before fusion." It would be helpful to see the entire article.

    Either way, have you asked the surgeon why he did the traction?

    Regards,
    Linda

  8. #8
    Join Date
    Aug 2007
    Location
    Ottawa, Canada
    Posts
    370
    My goodness this "traction" sounds pretty drastic - screws in the skull? I don't like this at all.
    Thanks for the post - another question to ask our doctor before we agree to surgery!
    Ruth
    Ruth, 50 years old (s-shaped 30 degree scoliosis) with degenerative disc disease, married to Mike. Mother to two children - Son 18 and daughter 14. Both have idiopathic scoliosis. Son (T38, L29) has not needed surgery to date. Daughter (March 08 - T62, L63).

  9. #9
    Join Date
    Nov 2005
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    404
    Seriously, it isn't as scary as it sounds. I had it done when I had my first surgeries when I was ten. They put the halo on during my anterior release, then I remained in halo tibial traction (pins in my ankles rather than above my knees) for two weeks, had the posterior fusion, and remained in the traction for a few more days after that. I spent the entire time lying flat on a rotatable bed (a "Stryka frame") which was flipped over every 2 hours to prevent bedsores. This was back in 1986 though, and these days more stable instrumentation mean that kids can get up much faster following their surgery and Stryka beds are very rarely used.

    Anyway, my main point is that it's not painful, nor really unpleasant. I didn't like the fact that a doctor had to come round every morning to tighten the bolts in my head with a spanner, but that was more a freaky feeling - not painful. I had a 76 degree thoracic curve which was the result of having had infantile scoliosis since I was diagnosed with a 62 degree/40 degree double curve at 6 months old, and it was very very stiff and difficult to pull straight. Body casts and Milwaukee braces could only ever hold it - it wouldn't correct at all - but with the halo traction, it was brought down to 45 degrees.

    Please don't be scared if this is an option for your child. Halos are still a standard piece of kit used in orthopaedic hospitals (mainly used for cervical fractures now) and there is little danger in having one put on. You can't feel the bolts in your head or your legs/ankles. You can actually have a halo put on whilst a patient is awake, but since it would be done to help in a surgery it would be done whilst your child is under anaesthetic. I had my halo taken off without any sedative or anaesthetic, they just gently loosen the bolts and they slide out.

    Hope that helps! Please don't panic

    Toni xx

  10. #10
    Join Date
    Aug 2007
    Location
    Ottawa, Canada
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    Wow Toni - sounds like something out of a Frankenstein movie - I had no idea this was done now or ever. I think you are a very brave person.

    Ruth
    Ruth, 50 years old (s-shaped 30 degree scoliosis) with degenerative disc disease, married to Mike. Mother to two children - Son 18 and daughter 14. Both have idiopathic scoliosis. Son (T38, L29) has not needed surgery to date. Daughter (March 08 - T62, L63).

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