![]() ![]() ![]() It should be noted that while this report discusses the occurrence of neurologic deficits during halo-gravity traction, this event is suitably rare. Because of the highly destabilizing nature of a circumferential decompression with only temporary fixation in the setting of a severe rigid deformity, this salvage plan would have been undertaken with a significant degree of caution. Certainly, however, had his neurologic exam not improved or declined further, he would have been brought emergently for surgical decompression for preservation of neurologic function which would have likely entailed a staged temporary construct that would have required a plan to return for his definitive construct on a subsequent date. His improving neurologic exam on just conservative measures was reassuring that we did have some time to prepare and move up his definitive surgical correction. Due to the complex configuration of his anatomy, we knew that there would be few salvage options for good bony fixation for a high-stress correction after a completely destabilizing circumferential decompression with vertebral column resection. However, because his surgical date had not been planned for several weeks, surgical adjuncts such as his custom cage and 3-dimensional spinal model for definitive surgical correction had not yet been processed. The option of immediate and emergent surgical intervention was considered after our patient fell and developed a significant decline in neurologic function. Keywords: pinal deformity, Halo-gravity traction, Neurologic deficit, Complications, Kyphoscoliosis We present here a case of neurologic decline in a patient with severe kyphoscoliosis who underwent HGT and discuss the management decisions associated with this challenging scenario. At his 4-month postoperative visit, he was now full strength in his lower extremities with complete resolution of his myelopathy. Postoperatively, he was noted to have a complete return to his baseline neurologic exam. He subsequently underwent a T1–L4 posterior spinal instrumentation and fusion with a T7–9 vertebral column resection. He subsequently sustained a ground-level fall and became paraparetic with a motor exam of 1–2/5. His traction weight was lowered to 11.3 kg. During week 7 at a goal traction weight of 18.1 kg, his distal lower extremity exam declined from 4+/5 to 2/5. His neurologic exam showed lower extremity myelopathy. Magnetic resonance imaging showed his thoracic spinal cord draped across his T7–9 apex. A 24-year-old male presents with severe thoracic kyphoscoliosis with > 180° of 3-dimensional deformity. Although halo-gravity traction (HGT) has been shown to be well-tolerated and safe, we report here a case of neurologic decline during treatment. Correction of severe spinal deformity is a significant challenge for spinal surgeons. ![]()
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