Establishing Consensus on the Best Practice Guidelines for Use of Halo Gravity Traction for Pediatric Spinal Deformity

Roye, Benjamin; Campbell, Megan; Matsumoto, Hiroko; Pahys, Joshua M.; Welborn, Michelle; Sawyer, Jeffrey R.; Fletcher, Nicholas D.; McIntosh, Amy L.; Sturm, Peter; Gómez, Jaime A.; Roye, David P.; Lenke, Lawrence G.; Vitale, Michael G.

doi:10.1097/bpo.0000000000001379

Cited by 22 publications

(20 citation statements)

References 20 publications

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“…Peng et al reported good outcomes in 7 patients (age range 12-40 years) treated with Gardner-Wells tong traction for a mean of 21 days. 11,17,20,23 All patients underwent posterior occipitocervical spinal fusion and avoided anterior surgery. HGT improves dens alignment but without the constraints of long-term immobilization required with Gardner-Wells traction.…”

Section: Basilar Invaginationmentioning

confidence: 99%

Halo-gravity traction for the treatment of pediatric cervical spine disorders

Glotzbecker

Birch

O'Neill

et al. 2020

Journal of Neurosurgery: Pediatrics

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OBJECTIVEHalo-gravity traction (HGT) is an effective and safe method for gradual correction of severe cervical deformities in adults. However, the literature is limited on the use of HGT for cervical spine deformities that develop in children. The objective of the present study was to evaluate the safety and efficacy of HGT for pediatric cervical spine deformities.METHODSTwenty-eight patients (18 females) whose mean age was 11.3 ± 5.58 years (range 2–24.9 years) underwent HGT. Common indications included kyphosis (n = 12), rotatory subluxation (n = 7), and basilar invagination (n = 6). Three children (11%) received traction to treat severe occipitocervical instability. For these 3 patients, traction combined with a halo vest, with bars attached rigidly to the vest, but with the ability to slide through the connections to the halo crown, was used to guide the corrective forces and moments in a specific and controlled manner. Patients ambulated with a wheelchair or halo walker under constant traction. Imaging was done before and during traction to evaluate traction efficacy. The modified Clavien-Dindo-Sink classification was used to categorize complications.RESULTSThe mean duration of HGT was 25 days (IQR 13–29 days), and the mean traction was 29% ± 13.0% of body weight (IQR 19%–40% of body weight). The mean kyphosis improved from 91° ± 20.7° (range 64°–122°) to 56° ± 17.6° (range 32°–96°) during traction and corresponded to a mean percentage kyphosis correction of 38% ± 13.8% (range 21%–57%). Twenty-five patients (89%) underwent surgical stabilization, and 3 patients (11%) had rotatory subluxation that was adequately reduced by traction and were treated with a halo vest as their definitive treatment. The mean hospital stay was 35 days (IQR 17–43 days).Nine complications (32%) occurred: 8 grade I complications (28%), including 4 cases of superficial pin-site infection (14%) and 4 cases of transient paresthesia (14%). One grade II complication (4%) was seen in a child with Down syndrome and a preexisting neurological deficit; this patient developed flaccid paralysis that rapidly resolved with weight removal. Six cases (21%) of temporary neck discomfort occurred as a sequela of a preexisting condition and resolved without treatment within 24–48 hours.CONCLUSIONSHGT in children is safe and effective for the gradual correction of cervical kyphosis, atlantoaxial subluxation, basilar invagination, and os odontoideum. Cervical traction is an additional tool for the pediatric spine surgeon if uncertainties exist that the spinal alignment required for internal fixation and deformity correction can be safely achieved surgically. Common complications included grade I complications such as superficial pin-site infections and transient paresthesias. Halo vest gravity traction may be warranted in patients with baseline neurological deficits and severe occipitocervical instability to reduce the chance of catastrophic movement.

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Section: Basilar Invaginationmentioning

confidence: 99%

Halo-gravity traction for the treatment of pediatric cervical spine disorders

Glotzbecker

Birch

O'Neill

et al. 2020

Journal of Neurosurgery: Pediatrics

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“…Jedoch sollte bei rigiden skoliotischen Fehlstellungen über 90°, bei ausgeprägten Kyphosen bzw. insbesondere bei Kombination der Fehlstellungen, vor allem im Kindesalter, an diese Möglichkeit gedacht werden [31].…”

Section: Fragenunclassified

“…kleiner Kinder die Halotraktion zur Anwendung kommt, um überhaupt erst einen Eingriff technisch sinnvoll und mit vertretbarem Aufwand möglich zu machen, zumal mobilisierende Verfahren in diesem Alter mit einer erhöhten Gefahr der Fusion verbunden sind [30,31]. Betrachtet man die verschiedenen Vor-und Nachteile bei diesen herausfordernden Krankheitsbildern, ist die präoperative Halotraktion im Sinne der Halo-Schwerkraft-Traktion bei entsprechender Erfahrung ein wirksames und sicheres Instrument.…”

Section: Fragenunclassified

“…Einerseits wird dieser Effekt in der Literatur häufig als quasi selbstverständliches Argument für diese Vorgehensweise angeführt [22] und mit Fallbeschreibungen [30] oder Fallserien belegt [32]. Die Konsensusempfehlungen der Arbeitsgruppe von Roye et al [31], kommen zu der Aussage, dass thorakale Kurven generell besser als lumbale auf eine Traktionsbehandlung ansprechen und empfehlen die Halotraktion damit auch zur Optimierung einer präoperativ eingeschränkten Lungenfunktion. Andererseits zeigt die Arbeit von Koller et al [15] im Verlauf keine statistisch messbare Verbesserung hinsichtlich der Lungenfunktion.…”

Section: Fragenunclassified

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Halo Fixator and Halo Traction – Value for the Treatment of Spinal Disorders in Childhood

et al. 2019

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The application of the Halo fixateur in case of spinal pathologies in childhood is a standardized technique. The halo fixateur may be used for treatment of injuries of the cervical spine, for additional stabilization following extended surgery at the cervical spine and their transitional regions as well as to achieve preoperative reduction in case of severe and rigid deformity. These indications are, referred to the early age, rare. However, the successful use of the Halo fixateur presumes a certain familiarity with the device and experiences regarding the underlying diseases to minimize related risks and to avoid possible complications. In this article the use and specific features regarding the application of the halo fixateur in childhood based on presented cases and the literature will be discussed.

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“…1 Children with severe scoliosis and/or kyphosis placed in halo traction improve their curve magnitude from 20% to 50% throughout their 4-to 8-week course of halo traction treatment. 2 We use halo gravity traction for many diagnoses, age ranges, and types of scoliosis. A halo, which is a metal ring around the head, is applied under general anesthesia.…”

Section: Introductionmentioning

confidence: 99%

Supervised Deep Breathing Exercises Improve Functional Aerobic Capacity in Patients with Severe Spinal Deformity

Zapata¹

2022

Journal of the Pediatric Orthopaedic Society of North America

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Background: Our institution has traditionally treated children with severe spine deformity using halo gravity traction (HGT) to improve curve magnitude and increase flexibility. Local Problem: Assessing the non-radiographic benefits of HGT such as pulmonary function, is difficult. Pulmonary function is commonly reflected by pulmonary function testing (PFT) which is dependent on MAXIMAL patient effort. Six-minute walk test (6MWT) reflects functional exercise capacity. Specific Aims: This quality initiative (QI) was performed to evaluate the addition of supervised deep breathing exercises (DBE) utilizing an incentive spirometer (IS) to supervised physical therapy exercise in patients with severe spinal deformity that require HGT. Methodology: A QI core team was established with the aim of improving the pulmonary function aspect of our HGT program. The team consisted of 1 orthopaedic surgeon, 1 quality improvement program manager, 2 physical therapists (PTs), and 1 respiratory therapist (RT). The QI core team met every 4 to 6 weeks to discuss patients and processes. Intervention: RTs supervised HGT patients performing DBE 4 times per day, and asked families to independently perform DBE 4 additional times per day. PTs performed the six-minute walk tests (6MWT). A pulse oximeter was used to monitor oxygen saturation levels. RTs performed the PFTs. The 6MWT and PFTs were performed prior to halo application, and every 2 weeks while in HGT treatment. Results: The intervention HGT patients who received supervised DBE (n=14) demonstrated significantly improved 6MWT scores from 1440±546 feet pre-halo to 1663±398 feet pre-surgery (p=0.02). A historic cohort of HGT patients who did not receive supervised DBE (n=10) demonstrated no significant changes in 6MWT scores at 1493±391 feet pre-halo and 1477±406 feet pre-surgery. Averaged forced vital capacity worsened 4±10% and average forced expire volume in one second worsened 1±8%. Conclusions: Children in HGT undergoing supervised DBE and physical therapy demonstrate improved functional aerobic capacity according to the 6MWT despite no improvement in pulmonary function tests.

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Establishing Consensus on the Best Practice Guidelines for Use of Halo Gravity Traction for Pediatric Spinal Deformity

Cited by 22 publications

References 20 publications

Halo-gravity traction for the treatment of pediatric cervical spine disorders

Halo-gravity traction for the treatment of pediatric cervical spine disorders

Halo Fixator and Halo Traction – Value for the Treatment of Spinal Disorders in Childhood

Supervised Deep Breathing Exercises Improve Functional Aerobic Capacity in Patients with Severe Spinal Deformity

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