Benefits and complications of halo-gravity traction in adolescents with severe idiopathic or secondary scoliosis prior to vertebral fusion. Series of 16 cases

Abstract

In the treatment of severe scoliosis, pre-surgical halo-gravity traction (HGT) achieves an increase in curve flexibility and in preoperative pulmonary function as well as a neurologic risk reduction following final surgery. Our aim was to describe the benefits and complications of HGT in adolescents with idiopathic scoliosis or secondary scoliosis while awaiting vertebral fusion. A descriptive and retrospective study. Sixteen patients admitted to hospital and carrying a HGT between January 2014 and December 2017 were included. The main judgment criteria were the height gain, the final weight of traction, the decrease in the Cobb angle, the gain in the forced vital capacity (FVC) and the description of complications. There were eight teenagers with an idiopathic scoliosis aged-mean (SD) 12.1(1.9) years old, a height gain of 7.6(2.3)cm, a final weight of traction of 13.7(3.9)kg corresponding to 37.2(7.5)% of body weight. Cobb angle mean(SD) of 97.5(8)° was reduced of 26.9(11.1)° at the end of traction. And a FVC gain mean (SD) of 12.4(8.8)%. Likewise, eight adolescents with a secondary scoliosis aged-mean(SD) 12.8(1.2) years old, a height gain of 9.2(2.8)cm, a final weight of traction of 12.7(1.3)kg corresponding to 38.9(11.6)% of body weight. Cobb angle mean(SD) of 100(13.8)° was reduced of 26.5(8.4)° at the end of traction. And a FVC gain mean(SD) of 7.1(9.7)%. The most frequent complications in the group of idiopathic scoliosis ( n = 8) were neck pain (75%), headache (37.5%), pin pain (25%), visual disorders, thorax pain and pin infection (12.5%). In the group of secondary scoliosis ( n = 8), neck pain (100%), headache (62.5%), back pain (50%), pin pain and anxiety (25%), neurological disorders and pin infection (12.5%). HGT was in general well tolerated and should be considered before vertebral fusion to improve spinal flexibility and respiratory function in idiopathic or secondary scoliosis.