Neuromuscular lordoscoliosis: an unusual response to post-operative halo-gravity traction

Purpose: To report the results of prolonged post-operative halo-gravity traction in a patient in whom the surgery had to be interrupted unexpectedly and for whom subsequently specific clinical circumstances contraindicated completion of the surgical procedure.

Methods: The patient was a 15-year-old male with severe cervico-dorsolumbar lordoscoliosis who was being studied for associated diffuse axonal injury. He performed halo-gravity traction for 12 weeks. Subsequent surgical management consisted of occipito-lumbar posterior instrumented fusion. During the surgical approach, electrocardiographic changes with hemodynamic decompensation were detected that did not improve with anesthetic reanimation. The intervention was stopped, the surgical wound was closed, and the patient was transferred to the intensive care unit (ICU). It was decided that a revision surgery with the aim to continue with the previous strategy would imply a high risk of perioperative morbidity and mortality.

Results: Orthopedic management was decided upon consisting of continued halo-gravity traction with wheelchair modification at home, which was extended to a period of 12 months because of the good results obtained in terms of cervicothoracic realignment. Two years after halo-gravity discontinuation, clinical and radiographic occipito-cervical alignment was good and the patient conserved certain occipito-cervical range of motion and had the capacity of maintaining a horizontal gaze.

Conclusion: We considered the outcome extraordinary and relevant in this complex and unusual patient. A longer follow-up will provide more data regarding the final outcome of this treatment.