Staged Halo-Pelvic Traction Combined With Posterior Spinal Fusion versus One-Stage Surgery for Severe Rigid Spine Deformity Requiring Three-Column Osteotomy: A Comparative Study.

Study designA retrospective cohort study.ObjectiveSevere rigid spine deformity presents major challenges in surgical correction. Although three-column osteotomies (3-CO) provide powerful correction, they are associated with prolonged operative time, increased blood loss, and high neurological risk. This study aimed to compare the radiographic correction, surgical parameters, and complication profiles between staged halo-pelvic traction combined with posterior spinal fusion (HPT+PSF) and one-stage posterior spinal fusion (PSF) in patients with severe rigid spine deformity requiring 3-CO.MethodsThis retrospective cohort study included 110 patients (mean age, 25.7 ± 8.5 years) with severe rigid deformity (Cobb angle or maximal kyphosis >90°, flexibility P = 0.004; 67.7% vs 54.5%, P P P P = 0.005) and neurological deficits (3.3% vs 14.0%, P = 0.042) were markedly lower in the HPT+PSF group. Although traction-related complications occurred in 16.7% of patients, all were transient and resolved after adjustment of HPT devices.ConclusionStaged HPT followed by PSF provides a safe and effective strategy for the management of severe rigid spine deformities. In terms of radiographic correction and perioperative safety profile, this staged approach demonstrated significant advantages over one-stage 3-CO, notably reducing operative time, blood loss, and neurological risks. Preoperative traction effectively decreases deformity stiffness and magnitude, facilitating safer and less invasive surgical correction.