Circular external fixation of the spine and pelvisfor insoluble spinal deformities

Most spinal deformities, even of great severity, can be managed by modern surgical techniques and implants. Some may be amenable to long-term preliminary halo-gravity traction (Sink et al., J Pediatric Orthop 21(4):519–524, 2001) preceding definitive spinal instrumentation. On a rare occasion, the severity of the spinal deformity, with or without infection and/or inadequate soft tissue coverage, will not allow the safe or effective implementation of these standard techniques.Dubousset (Rev Chir Orthop Suppl 177:144, 1991) was the first to describe the use of circular external stabilization of the spine and pelvis using fine-wire fixation in a patient with myelomeningocele and recalcitrant lumbar spinal deformity. We have treated seven patients with infected, unstable, and life-threatening pseudarthrosis, activities-of-daily-living-impeding hyperlordosis, or severe kyphosis and skin breakdown in the lumbar spine by hybrid circular fixation of the spine and pelvis, with or without gradual reduction of deformity and expert postoperative care. We here describe the evolution of our surgical and postoperative management techniques in these rare, otherwise, unsalvageable cases.