Spine Deform. 2026 Jul 29. doi: 10.1007/s43390-026-01514-8. Online ahead of print.
ABSTRACT
BACKGROUND: Skeletal intraoperative traction (IOT) has been proposed as an adjunct to posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) to facilitate deformity correction and reduce perioperative morbidity. However, its clinical benefit remains controversial, with conflicting evidence on radiographic outcomes and safety. This systematic review and meta-analysis aimed to determine whether skeletal IOT provides added benefit in patients undergoing one-stage PSF for AIS.
METHODS: A comprehensive search of PubMed, Embase, Scopus, Cochrane Library, and Web of Science was performed from inception to September 2025, following PRISMA guidelines. Eligible studies included patients with AIS undergoing one-stage PSF with skeletal IOT versus PSF without IOT. The primary outcomes were coronal main curve correction rate, operative time, intraoperative blood loss, and incidence of intraoperative motor-evoked potential (MEP) changes. Pooled estimates were calculated using common- and random-effects models. Between-study heterogeneity was assessed using the I2 statistic.
RESULTS: Eight studies comprising 693 AIS patients were included, of which six were comparative (426 IOT group vs. 267 non-IOT group). Under the common-effect model, IOT was associated with a significantly higher main curve correction rate (MD + 3.62, 95% CI 1.75-5.48) and lower blood loss (MD – 274.1 mL, 95% CI – 540.5 to – 7.6). Neither finding was confirmed under the random-effects model, which revealed extreme between-study heterogeneity for correction rate (I2 = 82.6%) and near-zero heterogeneity for blood loss (I2 = 1.5%). Intraoperative MEP changes occurred in 17.3% of IOT patients versus 3.0% of non-IOT controls (RR 3.49, 95% CI 0.83-14.71); all events were transient, and no permanent neurological deficit was recorded in any study.
CONCLUSIONS: Skeletal IOT does not demonstrate a statistically robust benefit over standard one-stage PSF for AIS when between-study heterogeneity is appropriately accounted for. IOT is associated with a higher incidence of transient intraoperative MEP changes, underscoring the mandatory role of continuous neurophysiological monitoring when this technique is employed. Future large and high-quality prospective studies are needed to further confirm the findings of the present analysis.
PMID:42527807 | DOI:10.1007/s43390-026-01514-8
