Eccentric cranial traction combined with concave-side distraction: a novel and effective management for correcting congenital cervical scoliosis

This study introduces eccentric cranial traction (ECT) as a traction method for congenital cervical scoliosis (CCS) at the craniovertebral junction (CVJ) and evaluates its benefits when combined with concave-side distraction surgery.

A retrospective analysis was conducted on 18 patients with CCS at the CVJ treated between 2019 and 2023 using ECT followed by concave-side distraction. Radiographic parameters were assessed at five time points: pre-operation, pre-traction, post-traction, post-operation, and final follow-up. Baseline demographic and surgical data were recorded. Patients were stratified into high- and low-responder groups based on the median value of the traction correction rate, and outcomes were compared between groups. The correlation between traction correction rate and surgical correction rate was also analyzed.

The median age at ECT initiation was 8 years, and the median duration of traction was 8 days. All patients presented with deformities involving the CVJ. ECT significantly reduced head-neck tilt from 16.5 ± 9.3° to 9.5 ± 5.9° (P < 0.001), yielding a mean traction correction rate of 43.1%. All patients subsequently underwent concave-side distraction at the CVJ, which resulted in a significant improvement in the Cobb angle from 36.0 ± 13.6° to 6.1 (IQR, 4.0, 10.9) (P < 0.05). At a median follow-up of 25.0 months (IQR, 24.0-30.0), the Cobb angle had increased slightly to 6.2° (IQR, 4.5-13.2), but the change was not statistically significant. Compared with the low-responder group, the high-responder group showed no significant differences in baseline parameters but had significantly shorter operative times (P < 0.05). No complications occurred during the traction period. Intraoperative complications included transient nerve root palsy and cerebrospinal fluid leakage, all of which resolved without long-term sequelae.

The combination of eccentric cranial traction and concave-side distraction offers a feasible and safe option for congenital cervical scoliosis at the craniovertebral junction. Traction responsiveness showed preliminary value in reflecting deformity flexibility and surgical complexity.