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Article: Iatrogenic biological fracture of the cervical spine during gradual halo traction for kyphotic deformity correction: case report
Title | Iatrogenic biological fracture of the cervical spine during gradual halo traction for kyphotic deformity correction: case report |
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Authors | |
Keywords | Cervical kyphosis Halo traction Iatrogenic fracture Deformity correction Osteotomy |
Issue Date | 2020 |
Publisher | BioMed Central Ltd. The Journal's web site is located at http://www.biomedcentral.com/bmcmusculoskeletdisord/ |
Citation | BMC Musculoskeletal Disorders, 2020, v. 21 n. 1, p. article no. 318 How to Cite? |
Abstract | Background:
Severe kyphotic deformities carry high risk for neurological injuries as osteotomies are often required for correction. Surgeons often utilize a staged approach for dealing with these conditions starting with a period of halo traction to stretch tight soft tissues and partially correct the deformity, followed by surgery. Halo traction is a relatively safe procedure and complications are uncommon. We report a unique case of iatrogenic fracture of the cervical spine during gradual halo traction for deformity correction of a severe cervical kyphosis.
Case presentation:
An 80-year-old female with previous cervical spine tuberculosis infection and C5-C6 anterior spinal fusion developed severe cervical kyphosis of 64° from C2-C6 and neck pain requiring deformity correction surgery. Gradual increase in traction weight was applied, aiming for a maximum traction weight of 45 pounds or half body weight. During the 1st stage halo-gravity traction, sudden neck pain and a loud cracking sound was witnessed during increase of the traction weight to 14 pounds. Imaging revealed a fracture through the C4 and reduction in kyphosis deformity to 11° from C2-C6. There was no neurological deficit. No further traction was applied and the patient underwent an in-situ occipital to T3 fusion without osteotomies. At 3-year follow-up, the patient was symptom-free and radiographs showed solid fusion and maintenance of alignment.
Conclusions:
Iatrogenic fracture may occur with halo traction. Elderly patients with osteoporotic and diseased bone should be closely monitored during the treatment. A fracture without complications was a fortunate complication as the patient was able to avoid any high-risk osteotomies for deformity correction.
Level of evidence:
IV |
Persistent Identifier | http://hdl.handle.net/10722/283416 |
ISSN | 2023 Impact Factor: 2.2 2023 SCImago Journal Rankings: 0.714 |
PubMed Central ID | |
ISI Accession Number ID |
DC Field | Value | Language |
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dc.contributor.author | Lim, ASL | - |
dc.contributor.author | Sali, AAB | - |
dc.contributor.author | Cheung, JPY | - |
dc.date.accessioned | 2020-06-22T02:56:08Z | - |
dc.date.available | 2020-06-22T02:56:08Z | - |
dc.date.issued | 2020 | - |
dc.identifier.citation | BMC Musculoskeletal Disorders, 2020, v. 21 n. 1, p. article no. 318 | - |
dc.identifier.issn | 1471-2474 | - |
dc.identifier.uri | http://hdl.handle.net/10722/283416 | - |
dc.description.abstract | Background: Severe kyphotic deformities carry high risk for neurological injuries as osteotomies are often required for correction. Surgeons often utilize a staged approach for dealing with these conditions starting with a period of halo traction to stretch tight soft tissues and partially correct the deformity, followed by surgery. Halo traction is a relatively safe procedure and complications are uncommon. We report a unique case of iatrogenic fracture of the cervical spine during gradual halo traction for deformity correction of a severe cervical kyphosis. Case presentation: An 80-year-old female with previous cervical spine tuberculosis infection and C5-C6 anterior spinal fusion developed severe cervical kyphosis of 64° from C2-C6 and neck pain requiring deformity correction surgery. Gradual increase in traction weight was applied, aiming for a maximum traction weight of 45 pounds or half body weight. During the 1st stage halo-gravity traction, sudden neck pain and a loud cracking sound was witnessed during increase of the traction weight to 14 pounds. Imaging revealed a fracture through the C4 and reduction in kyphosis deformity to 11° from C2-C6. There was no neurological deficit. No further traction was applied and the patient underwent an in-situ occipital to T3 fusion without osteotomies. At 3-year follow-up, the patient was symptom-free and radiographs showed solid fusion and maintenance of alignment. Conclusions: Iatrogenic fracture may occur with halo traction. Elderly patients with osteoporotic and diseased bone should be closely monitored during the treatment. A fracture without complications was a fortunate complication as the patient was able to avoid any high-risk osteotomies for deformity correction. Level of evidence: IV | - |
dc.language | eng | - |
dc.publisher | BioMed Central Ltd. The Journal's web site is located at http://www.biomedcentral.com/bmcmusculoskeletdisord/ | - |
dc.relation.ispartof | BMC Musculoskeletal Disorders | - |
dc.rights | BMC Musculoskeletal Disorders. Copyright © BioMed Central Ltd. | - |
dc.rights | This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. | - |
dc.subject | Cervical kyphosis | - |
dc.subject | Halo traction | - |
dc.subject | Iatrogenic fracture | - |
dc.subject | Deformity correction | - |
dc.subject | Osteotomy | - |
dc.title | Iatrogenic biological fracture of the cervical spine during gradual halo traction for kyphotic deformity correction: case report | - |
dc.type | Article | - |
dc.identifier.email | Cheung, JPY: cheungjp@hku.hk | - |
dc.identifier.authority | Cheung, JPY=rp01685 | - |
dc.description.nature | published_or_final_version | - |
dc.identifier.doi | 10.1186/s12891-020-03350-x | - |
dc.identifier.pmid | 32438900 | - |
dc.identifier.pmcid | PMC7243305 | - |
dc.identifier.scopus | eid_2-s2.0-85085155775 | - |
dc.identifier.hkuros | 310634 | - |
dc.identifier.volume | 21 | - |
dc.identifier.issue | 1 | - |
dc.identifier.spage | article no. 318 | - |
dc.identifier.epage | article no. 318 | - |
dc.identifier.isi | WOS:000537080800003 | - |
dc.publisher.place | United Kingdom | - |
dc.identifier.issnl | 1471-2474 | - |