The Use of Halo-Gravity Traction and Vertebral Column Resection to Treatc Hildren with Severe Kyphosis. Results and Complications

Introduction: Children with severe kyphosis are prone to developing neurologic compromise, poor respiratory function and possible early death. Early identification and surgical intervention has proven to be effective. However they carry the highest surgical risk of all the spine deformities. Objectives: To present the surgical results and complications of patients with severe kyphosis treated at the Foundation of Orthopedic and complex Spine (FOCOS) orthopedic hospital in Ghana with a combination of prolonged Halo gravity traction, Vertebral Column resection (VCR) and spinal stabilization. Methods: A consecutive series of 20 consecutive pediatric patients with severe kyphotic deformities were treated with Halo gravity traction and Vertebral column resection at a single center. We gathered the following demographic and clinical data: age, gender, BMI, diagnosis, procedure, Intraoperative monitoring (IOM) events, post operative complications. Results: 2 groups of 20 patients, 7 Early onset patients under 10 years with congenital kyphosis < 180 degrees (Group 1 N=7) and 13 adolescents patients with Kyphosis exceeding 180 degrees (Group 2 N=13). All the patients were treated with VCR. Group 1 averageage 7.7 +/3 years; BMI 17.7 +/2.8). Kyphosis averaged 85 degrees (70-150) and improved to 41 post op.(30-100). 50% (n=7) had intra-operative monitoring (IOM) changes that improved with corrective maneuvers and blood pressure elevation. 3 out of 5 patients with proximal junctional kyphosis (PJK) required a re-operation, one of whom also had additional procedure for infection. Group 2 patients included Congenita-11patients and Neurofibromatosis -2 patients. Average age: 17.8years; Sagittal deformity average 211deg and corrected to 53deg (74% correction). Intra-op spinal cord monitoring alerts occurred in 8 patients and post operative neurologic deficits occurred in 5 patients (1 permanent paraplegia) and 1 Post op mortality. Conclusions: Severe kyphosis ofcongenital or Neurofibromatosis in early onset or adolescents patients can be safely treated with vertebral column resection. Prolonged Halo gravity traction is helpful to obtain partial deformity correction prior to definitive surgery. Surgery provides excellent outcomes but with a high complication rate. Half of these cases had some neuro-monitoring changes that ultimately improved without lasting neurologic deficit. Proximal junctional kyphosiswas the most common complication requiring reoperation among the early onset group of patients.