Halo Gravity Traction Can Mitigate Preoperative Risk Factors and Early Surgical Complications in Complex Spine Deformity

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dc.contributor.authorIyer, S.
dc.contributor.authorBoachie-Adjei, O.
dc.contributor.authorDuah, H.O.
dc.contributor.authorYankey, K.P.
dc.contributor.authorMahmud, R.
dc.contributor.authorWulff, I.
dc.contributor.authorTutu, H.O.
dc.contributor.authorAkoto, H.
dc.contributor.authorFOCOS Spine Research Group
dc.date.accessioned2019-05-28T10:59:38Z
dc.date.available2019-05-28T10:59:38Z
dc.date.issued2019-05
dc.description.abstractSTUDY DESIGN: Retrospective review of prospective cohort. OBJECTIVE: We sought to examine the role of halo gravity traction (HGT) in reducing preoperative surgical risk. SUMMARY OF BACKGROUND DATA: The impact of HGT on procedure choice, preoperative risk factors, and surgical complications has not been previously described. METHODS: Patients treated with HGT before primary surgery were included. The FOCOS Score (FS) was used to quantify operative risk. FS was calculated using patient-factors (ASIA, body mass index, etiology), procedure-factors (PcF; osteotomy planned, number of levels fused, etc.), and curve magnitude (CM). Scores ranged from 0 to 100 with higher scores indicating increased risk. FS was calculated before and after HGT to see how changes in FS affected complication rates. RESULTS: A total of 96 patients were included. Halo-related complications occurred in 34% of patients but revision was required in only 8.3%. Average FS improved by 18 points after HGT. CM, PcF, and patient-factors all improved (P < 0.05). The greatest changes were in CM and PcF. The planned rate of three-column osteotomies dropped from 91% to 38% after HGT. FS (area under the curve [AUC]: 0.68, P = 0.023) and change in FS (AUC: 0.781, P < 0.001) was successfully able to predict the rate of surgical complications. A preoperative FS of 74 was identified as a cut-off for a higher rate of surgical complications (sensitivity 58.8%, specificity 74.7%). Patients with a reduction in FS <  = 10pts were five times more likely to have a complication (relative risk 5.2, 95% confidence interval: 1.9-14.6, P < 0.001). A multivariate regression showed that change in FS was an independent predictor of complication rates (P < 0.05). CONCLUSION: FS can successfully predict surgical risk in pediatric patients with complex spinal deformity. Preoperative HGT can reduce FS and surgical risk by improving CM, lowering three-column osteotomies use, and improving body mass index. A reduction in FS after HGT predicts a lower rate of surgical complications. LEVEL OF EVIDENCE: 3.en_US
dc.identifier.otherdoi: 10.1097/BRS.0000000000002906
dc.identifier.otherVolume 44 - Issue 9 - p 629-636
dc.identifier.urihttp://ugspace.ug.edu.gh/handle/123456789/30346
dc.language.isoenen_US
dc.publisherSpineen_US
dc.titleHalo Gravity Traction Can Mitigate Preoperative Risk Factors and Early Surgical Complications in Complex Spine Deformityen_US
dc.typeArticleen_US

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