Surgical Strategies of Staged Spinal Traction-Fusion for Severe Scoliosis in Osteogenesis Imperfecta Type IV: A Case Report and Literature Review.

BACKGROUND

To describe a staged surgical protocol combining halo-pelvic traction (HPT) and posterior spinal fusion (PSF) for severe scoliosis in a patient with osteogenesis imperfecta (OI) type IV and to evaluate its outcomes. Given the paucity of population-level data on spinal orthoses in OI, this report highlights a tailored surgical approach for this high-risk population.

CASE PRESENTATION AND MANAGEMENT: A 16-year-old girl with OI type IV and progressive scoliosis underwent a 2-stage correction: (1) preoperative HPT for 3 months to reduce coronal deformity and optimize spinal alignment, followed by (2) PSF with all-pedicle-screw instrumentation. The staged protocol achieved successful deformity correction without neurological or implant-related complications. All pedicle screws were safely placed despite osteopenic bone. At follow-up, radiographic outcomes were maintained, and the patient reported improved posture and function. Minor surgical differences and literature review are highlighted for multimodal management.

CONCLUSION

Progressive scoliosis in patients with OI can be effectively managed through structured, phased therapeutic programs, with the combined approach of HPT and PSF representing a significant surgical intervention strategy.

CLINICAL RELEVANCE: The clinical significance of this approach lies in transforming the management of a challenging rare disease-progressive scoliosis in osteogenesis imperfecta-from an empirical endeavor into a structured, systematic clinical pathway, while providing a validated technical combination for its most critical surgical intervention.