Intraoperative Skull-Femoral Traction in Posterior Spinal Arthrodesis for Adolescent Idiopathic Scoliosis
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STUDY DESIGN: Retrospective, single-center cohort study. OBJECTIVE: To study how the systematic use of intraoperative skull-femoral traction (IOSFT) in posterior arthrodesis for adolescent idiopathic scoliosis impacts perioperative outcomes and health resource utilization. SUMMARY OF BACKGROUND DATA: Large scoliosis curves have been associated with increased morbidity and utilization of health resources. When used with reliable neurophysiological monitoring, IOSFT has shown to be safe and to reduce curve magnitude intraoperatively. Thus, we hypothesized that the systematic use of IOSFT may contribute to reducing health resource utilization by reducing curve magnitudes intraoperatively. METHODS: Seventy-three consecutive patients with adolescent idiopathic scoliosis who underwent single-stage posterior spinal arthrodesis from 2008 to 2012 at a tertiary children's hospital were identified. Forty-five patients were operated with IOSFT (traction group) and 28 patients were operated without IOSFT (nontraction group). Outcome measures included operative time, calculated blood loss, blood transfusion requirement, traction-related complications, and cost comparisons. RESULTS: Operative time was 375.6 minutes for the traction group (P=0.0001) and 447.6 minutes for the nontraction group. Calculated blood loss was significantly less in the traction group (P=0.027). Thirty-three percent of patients in the traction group required blood transfusion compared with 64% of patients in the nontraction group (P=0.01, absolute risk reduction of 31%). There was no significant difference in curve magnitude correction (P=0.49). There were no significant complications with the use of traction. There was a significant reduction in cost per surgical procedure in the traction group (P=0.0003). CONCLUSION: The systematic use of IOSFT in posterior spinal arthrodesis for adolescent idiopathic scoliosis contributed to significant reductions in health resource utilization, with no added morbidity. Further research is warranted to investigate the generalizability of these findings. LEVEL OF EVIDENCE: 4.
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