SynthesisFrontiers in pediatrics2026
Intraoperative traction in posterior spinal fusion for adolescent idiopathic scoliosis: an updated systematic review and meta-analysis of correction, perioperative, and safety outcomes.
Synthesis in Frontiers in pediatrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
5 authors.
Funding
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Abstract
Background: Intraoperative traction is used during posterior spinal fusion or posterior spinal instrumentation for adolescent idiopathic scoliosis (AIS), but the comparative evidence is still limited and clinically heterogeneous. Previous reviews have also varied in whether they combined preoperative traction, traction radiographs, severe-AIS technical cohorts, and neuromonitoring studies with direct intraoperative traction-vs.-nontraction comparisons. Methods: This systematic review and meta-analysis followed the PRISMA 2020 statement and was registered in PROSPERO (CRD42023432276). PubMed via the National Library of Medicine, Web of Science Core Collection via Clarivate, and Embase via Elsevier were searched from inception to February 22, 2026. The core quantitative synthesis was limited to comparative AIS studies that evaluated intraoperative traction vs. no intraoperative traction during posterior spinal fusion or posterior spinal instrumentation. Severe-AIS, traction-weight, resource-utilization, and neuromonitoring studies were summarized separately. Continuous outcomes were pooled as mean differences (MDs), and dichotomous outcomes as risk ratios (RRs). Random-effects models with Hartung-Knapp adjustment were used for the primary inference. Results: Eighteen studies were included in the systematic review, and five direct comparative studies contributed to the core meta-analysis. Intraoperative traction showed a favorable but imprecise association with correction rate (4 studies; 450 participants; MD, 5.54 percentage points; 95% CI, -0.18 to 11.27; Conclusions: Direct comparative evidence did not demonstrate a statistically significant improvement in coronal correction under Hartung-Knapp inference, and the available data were insufficient to establish a reduction in transfusion. The correction point estimate favored traction, but the finding is exploratory and the certainty of evidence is very low because of sparse comparative data, heterogeneity, imprecision, and residual confounding. Reversible intraoperative neuromonitoring alerts should be distinguished from permanent postoperative neurological deficits.
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