Feasibility of modified halo-pelvic distraction technique in the management of severe spinal deformities in low- and middle-income countries: a pilot study in East Africa

Abstract

Background and objectives: Paediatric spine deformity, often arising from congenital or neuromuscular causes, can significantly impair cardiopulmonary and intra-abdominal function. Early identification and timely management are crucial to slowing curve progression. However, in LMICs, patients present late with severe curvatures exceeding 90°. Preoperative reduction is useful to mitigate surgical risks. This study assessed the feasibility of a modified halo-pelvic distraction device, focusing on major curve correction and complication rates.

Methods: Patients with severe scoliosis were enrolled from November 2023-October 2024, each undergoing treatment with a modified halo-pelvic Ilizarov distraction device over a 13-week period. Radiographic major curve changes, neurological function, and complication rates were assessed at defined treatment intervals.

Results: Seven patients were included, with a median age of 15 years (IQR 14-20); four were male. The baseline median major curve was 110° (IQR 92°-120°), including three cases of adolescent idiopathic scoliosis (AIS). Following 13 weeks of distraction, the median curve improved to 69°, representing a 63% correction (p = 0.027). One patient developed transient lower limb weakness (MRC 2/5), and another experienced superior mesenteric artery syndrome; both resolved after adjustment of traction forces and subsequent removal of the device. Definitive corrective surgery was performed in six patients, achieving a final curve correction to 49° (32°-55°).

Conclusions: The modified halo-pelvic Ilizarov distraction technique can be a feasible preoperative strategy for achieving meaningful correction in severe spinal deformities. Expanding the use of this technique especially in LMICs could offer greater insight into its potential benefits and safety.

Keywords: Halo-pelvic traction; Low- and middle-income countries (LMICs); Pediatric scoliosis; Scoliosis surgery; Surgical education.