The Use of Halo Gravity Traction in Severe, Stiff Scoliosis

Abstract

Purpose: The correction of severe, stiff scoliosis in children is challenging. One method used to reduce the risk is preoperative halo gravity traction (HGT). In this study, the authors sought to define the efficiency and safety of HGT and characterize the chronology of the correction seen. Method: A consecutive group of pediatric patients with severe spinal deformities was treated with HGT before definitive correction. A standard protocol with the daily addition of weight to 50% of body weight at 3 weeks was used. Traction remained in place until signs of impending neurological complication or 6 weeks, whichever was sooner. Results: Twenty-four patients were included with a mean age of 11.8 years. The mean coronal deformity was 123 degrees, with a T1-L5 height of 234 mm. The mean duration of traction was 42 days with a mean improvement in height of 72 mm with 82% occurring over the first 3 weeks. Hundred percent of the angular and 98% of T1-L5 height correction was reached by 6 weeks. One patient showed early signs of a cranial nerve palsy prompting early surgery and 8 patients showed pin loosening, 1 of which required revision of their halo. One patient underwent a slower progression of traction because of transitory urinary disturbance. Following fusion, angular correction of the major curve was 49%. Conclusion: HGT is a safe treatment for severe, stiff scoliosis because it can respond to early signs of impending neurological impairment. The first 3 weeks of treatment, reaching 50% of body weight as a traction force accounts for 80% of correction, with the remaining 20% in the following 2 weeks. At least 4 weeks of traction is recommended when following this protocol.

Three-stage correction of severe idiopathic scoliosis with limited skeletal traction during a humanitarian surgical mission: illustrative case

“…This reduces the amount of correctional force required during surgery, thus minimizing the risk of surgical complications. 12 , 13 Other benefits of HGT include improved pulmonary function and nutritional status of the patient. 4 , 14 , 15 The increased nutritional status is most beneficial for patients who are underweight preoperatively and risk developing issues with wound care and instrumentation prominence later in their postoperative course.…”

The Use and Complications of Halo Gravity Traction in Children with Scoliosis

“…The study was performed on 24 patients with a mean age of 11.8 years. The most improvement (82%) occurred in the first 3 weeks and the mean duration of traction was 42 days [ 29 ]. Hwang et al obtained the most correction (28.2%) within 1 week and observed that significant changes in the curvature, a correction of 34%, occurred in up to 2 weeks [ 30 ].…”

“…Bogunovic et al had a complication rate of 27% (transient nystagmus, upper extremity numbness, pin site erythema/infection, unilateral miotic pupil, and progression of myelopathy) and they used a traction weight for each patient of 33.5% of their body weight [ 28 ]. Rocos et al, of the 24 patients, had 1 patient with early signs of cranial nerve palsy, 8 patients with pin loosening, and one with transitory urinary disturbance [ 29 ]. In their study of 59 patients, Hwang et al recorded complications in 10 cases: vomiting, intolerable pin site pain, pin site infection, skull fracture, and pelvic wound [ 30 ].…”

Indications and Efficacy of Halo-Gravity Traction in Pediatric Spinal Deformity

“…Improvement can be measured in curve correction (in both coronal and sagittal planes), functional improvements (pulmonary and feeding function), and trunk length and shift. Previous studies of pediatric populations have shown average improvements in curve severity ranging from 35% to 50% angular correction of both coronal and sagittal plane deformities 10,31,40 . Changes in trunk length are noted to average 5 to 6 cm 30,31 .…”