The Use of Halo Gravity Traction in the Treatment of Severe Early Onset Spinal Deformity

Abstract

Study Design. Retrospective Review of Prospective cohort. Objective. To describe the feasibility of preoperative halo gravity traction (HGT) with subsequent growing rod/guided growth (GR/GG) placement in early onset spinal deformity (EOSD). Summary of Background Data. In children with severe EOSD, primary implantation of GR/GG constructs is not always possible. We describe a staged protocol with preoperative HGT followed by GR/GG implantation. Methods. EOSD patients treated with HGT prior to GR/GG implantation were included. HGT used traction up to 50% body weight for 4 to 29 weeks. Pulmonary function tests (PFTs) were performed before and after HGT. Coronal Cobb (CC) and Sagittal Cobb (SC) angles were measured on the Pre-HGT, Post-HGT and 6 week postop x-rays. Results. Thirty patients were included. Average age at GR/GG implantation was 9 years. Most cases (n = 24, 80%) were idiopathic. Most pts had kyphoscoliosis (n = 16, 53.3%). Pre-HGT CC averaged 112 ± 22° and SC averaged 106 ± 26°. CC and SC improved 29% after HGT. There was a significant improvement in body mass index following HGT. CC improved further to 70 ± 14° (36% vs. pre-HGT) and SC to 63 ± 21° (41%) with GR/GG placement. HGT-related complications occurred in nine patients (30%); eight pin site infections, one cranial abscess. Most HGT complications were managed with local pin care and oral antibiotics. Halo revision was required in two pts (6.7%). There was no change in PFTs with HGT (P > 0.05). Averagely, 14 levels were spanned during GR/GG implantation; two patients required vertebral column resection. Surgical complications occurred in nine (30%) patients. At average 16 month follow-up, seven patients (23.3%) required reoperation. Conclusion. Preoperative HGT can make severe EOSD curves amenable to GR/GG implantation. HGT results in ∼30% correction with improvement to ∼35–40% following GR/GG. HGT has a 30% complication rate but most are pin-site infections managed with pin-site care and oral antibiotics; 6.7% of patients require revision. Level of Evidence: 4

Does Preoperative Halo-Gravity Traction Reduce the Degree of Deformity and Improve Pulmonary Function in Severe Scoliosis Patients With Pulmonary Insufficiency? A Systematic Review and Meta-Analysis

“…After thorough search and screening, a total of 10 articles providing radiographic and pulmonary function data pre-and post-halo-gravity traction were included; among which, seven studies were preserved for meta-analysis (7)(8)(9)(10)(11)(12)(13). The article selecting process is shown in Figure 1.…”

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

“…In retrospektiven Fallserien ohne vorheriges Release konnte eine Reduktion der Hauptkrümmung durch die Traktion zwischen 35 und 46 % gezeigt werden [25,29]. Diese Ergebnisse (Korrektur von im Durchschnitt 29°) konnten auch in der bisher größten Fallserie von mit Halotraktion behandelten Early-Onset-Skoliosen sowohl für die koronare als auch für die sagittale Ebene bestätigt werden [30]. Dies zeigt, dass die Indikation kritisch zu stellen ist und es sich um Einzelfallentscheidungen handelt.…”

“…Ein weiter mögliches Ziel der präoperativen Traktion, die mögliche Verbesserung der bei ausgeprägten Deformitäten in diesem Alter oft eingeschränkten pulmonalen Funktion, wird kontrovers diskutiert. 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.…”

“…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.…”

Postoperative Pulmonary Complications in Complex Paediatric and Adult Spine Deformity: A Retrospective Review of Consecutive Patients Treated at SRS GOP Site in Ghana

“…Various perioperative measures have enabled us to achieve such comparable pulmonary complication rates despite the complexities of the spine deformity cases present in this cohort. These included utilization of pre-op Halo Gravity Traction (HGT)[13,[28][29], adequate pre-op nutritional rehabilitation[30], elective overnight ventilation after surgery for patients with poor FVC and early application of tracheostomy at the earliest sign of difficulty in weaning off ventilation.…”