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.

Overview

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.