Halo-gravity Traction Research Articles

Preoperative halo-gravity traction combined with one-stage posterior spinal fusion surgery following for severe rigid scoliosis with pulmonary dysfunction: a cohort study

BackgroundTo assess the efficacy of preoperative halo-gravity traction (HGT) in treating severe spinal deformities, evaluating radiological outcomes, pulmonary function, and nutritional status.MethodsThis study retrospectively included 33 patients with severe spinal deformity who were admitted to our department from April 2018 to January 2022. All the patients underwent HGT prior to the posterior spinal fusion corrective surgery, with no patients having undergone anterior or posterior release procedures. The correction of deformity, pulmonary function tests (PFTs), and nutritional status data were collected and analyzed before and after HGT.ResultsA total of 33 patients (9 males, 24 females) were finally included in this study with an average age of 17.79 ± 7.96 (range 12–29) years. Among them, 20 patients were aged ≤ 16 years. The traction weight started from 1.5 kg and raised to 45.2 ± 13.2% of body weight on average progressively, with the average traction duration of 129 ± 63 days. After traction, the main curve was corrected from an average of 120.66 ± 3.89° to 94.88 ± 3.35°, and to 52.33 ± 22.36° (53%) after surgery(P < 0.05). PFTs also showed a significant increase in FVC%, FEV1%, and MEF% after traction [43.46 ± 14.76% vs. 47.33 ± 16.04%, 41.87 ± 13.68% vs. 45.19 ± 15.57%, and 40.44 ± 15.87% vs. 45.24 ± 17.91%, p < 0.05]. Total protein, albumin, and BMI were used as indicators of nutritional status. TP and albumin were significantly improved after traction, from 67.24 ± 5.43 g/L to 70.68 ± 6.98 g/L and 42.40 ± 3.44 g/L 45.72 ± 5.23 g/L, respectively(P < 0.05). No significant difference was found in deformity correction and lung function improvement between patients with traction for more or less than three months (p > 0.05). Two patients developed transient brachial plexus palsy during traction.ConclusionsHalo-gravity traction can partially correct spinal deformity, enhance pulmonary function. And HGT has been shown to facilitate an improved nutritional status in these patients. It could be used as a preoperative adjuvant treatment for severe spinal deformity. However, according to the study, a traction period longer than three months may not be necessary.

Surgical Treatment Strategies for Severe and Neglected Spinal Deformities in Children and Adolescents without the Use of Radical Three-Column Osteotomies.

Background: Severe spinal deformity manifests as a pronounced deviation from the normal curvature of the spine in the frontal, sagittal, and horizontal planes, where the coronal plane curvature exceeds 90 degrees and may coincide with hyperkyphotic deformity. The most severe deformities exhibit rigidity, with flexibility below 30%. If left untreated or improperly treated, these deformities can result in serious complications associated with progression of the curvature. A combination of surgical techniques is frequently employed to attain optimal outcomes and minimize the risk of complications. The overall medical condition of the patient, their capacity to endure extensive procedures, the expertise of the surgeon, and the resources available all play significant roles in determining the course of management. A systematic and thorough review of the relevant literature was conducted utilizing a variety of electronic databases. The primary objective of this study was to scrutinize the surgical techniques commonly employed in complex spine surgeries for the management of severe scoliosis without resection vertebral body techniques, with higher potential risk of major complications, including permanent neurological deficit. Conclusions: Halo-gravity traction, halo femoral traction, and all techniques for releases of the spine (anterior, posterior, or combine), as well as thoracoplasty, have demonstrated significant effectiveness in managing severe and rigid idiopathic scoliosis. The combination of several of these methods can lead to optimal alignment correction without the need to perform high-risk techniques involving three-column osteotomies. Surgeons must customize the indications based on factors such as available resources, characteristics of the deformity, and the patient's individual profile. Surgical correction of severe scoliosis without vertebral body resection surgeries decreases the potential risks related to neurological and pulmonary complications while providing significant clinical improvement outcomes. The powerful Ponte osteotomy is indicated for severe scoliosis, curves with poor flexibility, for better restoration of hypokyphosis, and decrease of hyperkyphosis. These corrective techniques combined with HGT or temporary internal distraction rods are recommended as viable options for managing individuals with severe rigid spine deformity characteristics. Therefore, they also should be considered and performed by a proficient surgical team. The presence of neuromonitoring is crucial throughout these procedures.

Implementing a Halo Gravity Traction Program: A Multidisciplinary Endeavor.

Halo gravity traction (HGT) is a preoperative modality for children with severe spinal deformity used to optimize spine flexibility and balance while decreasing the likelihood of neurologic injury. HGT is a dependable solution for these challenging spinal deformities. Aligning treatment guidelines and providing resources, education, and training for staff are key components for a successful HGT program. The HGT program at Children's Mercy Hospital was then developed with a systems approach with the holistic goal of multidisciplinary collaboration with physical/occupational therapy, hospital medicine, pulmonology, psychology, nutrition, child life, and complex care management. Education, research, and national collaboration to standardize this therapy should improve patient safety and support quality improvement.

Radiological and Pulmonary Results of Surgical Treatment of Severe Idiopathic Scoliosis Using Preoperative Halo Gravity Traction Compared with Less Invasive Temporary Internal Distraction in Staged Surgery in Adolescents.

Background: Severe and rigid scoliosis represents a type of spinal deformity characterized by a Cobb angle exceeding 90° and a flexibility of less than 30%. Halo spinal traction remains the established standard for managing severe scoliosis, although alternative approaches such as temporary internal distraction rods and staged surgical correction exist. The primary objective of this investigation was to compare two cohorts of patients treated using these distinct methods to ascertain any divergences in terms of surgical and radiological outcomes, pulmonary function (PF), and quality of life (QoL). Methods: This study encompassed a total of 62 pediatric patients meeting the specified criteria, which included severe idiopathic scoliosis (major Cobb curve >90) and flexibility <30%. Group 1 (G1) underwent surgical intervention involving preoperative Halo gravity traction (HGT) succeeded by posterior spinal fusion (PSF). On the other hand, Group 2 (G2) underwent a two-stage procedure starting with a less invasive temporary internal distraction technique (LITID) prior to PSF. The radiological outcomes, PF, and QoL were documented and assessed over a monitoring period ranging from 2 to 5 years. Results: The average preoperative major curves (MCs) measured 124° and 122° in G1 and G2, respectively (p < 0.426). Initial flexibility, as observed in preoperative bending films, ranged from 18% in G1 to 21% in G2 (p < 0.001). Following the ultimate surgical intervention, the MCs were corrected to 45° and 37.4° in G1 and G2, respectively (p < 0.001). The percentage correction of the MCs was higher in G2 (63% vs. 70% in G1 and G2, respectively), with significant between-group disparities (p < 0.001). The mean preoperative thoracic kyphoses (TKs) were 96.5° in G1 and 92° in G2 (p = 0.782), which were rectified to 45.8° in G1 and 36.2° in G2 (p < 0.001), equating to correction rates of 55% and 60% in the respective groups. Initially, G2 exhibited lower values for the percentage of predicted lung volume (FVC) and predicted FEV1 compared with G1 (49% and 58% vs. 54.5% and 60.8%; N.S.). Nonetheless, both groups demonstrated enhancements in their FVC and FEV1 values over the follow-up period. Conclusions: The surgical management of severe and untreated spinal curvatures in the pediatric and adolescent population can be considered safe, with a tolerable incidence of minor complications. LITID emerges as a method offering improved QoL and pulmonary function, achieving notably substantial average corrections in deformity by 70% in the coronal plane and 60% in the sagittal plane, alongside a mean increase in trunk height of 10.8 cm. Furthermore, a typical reduction of 76% in rib humps and enhancements in respiratory function, as indicated by improvements in 1 s predicted forced expiratory volume (by 25-56%) and forced vital capacity (by 35-65%), were achieved, leading to a clinically and statistically significant enhancement in QoL when evaluated using SRS-22r, without resorting to more radical, high-risk procedures.

Evaluation of the Effect of Halo Gravity Traction on Lung Volume in Advanced and Severe Kyphoscoliosis Patients in Chest Radiography

Aim: To evaluate the effect of preoperative halo gravity traction on lung volume in patients with advanced and rigid kyphoscoliosis using planimetric measurements from chest radiography. Method: Ten patients with a mean age of 20.5±0.9 with a diagnosis of severe and severe kyphoscoliosis who underwent halo gravity traction between 2019 and 2021 were included in our study. Direct chest radiographs taken before and after traction were analyzed retrospectively. In order to evaluate the effectiveness of traction, planimetric evaluations were made on radiographs. Results: In the evaluation of radiological parameters, mean thoracic coronal cobb angle, lumbar cobb angle, thoracic kyphosis angle, lumbar lordosis angle, C1-S1 distance and lung volume before and after the procedure were 96.670°±8.4535°, 88,090°±4.5989°, 37.020°±11.5893°, 38.540°±11.1269°, 73.150°±7.0412°, 65.590°±7.3927°, 59.100°±9.5467°, 55.100°±9.0238°, It was 371.590mm± 64.2410mm, 408.330 mm±80.8229 mm and 967.730 mm3±318.404 mm3, 1155.180mm3±332.868 mm3. The decrease in thoracic kyphosis, lumbar lordosis, thoracic cobb and lumbar cobb angles and the increase in lung volume and distance between C1-S1 were statistically significant (p&amp;lt;0.05). Conclusion: Traction application is a safe method for deformities. It is effective in correcting sagittal and coronal curvatures. It is a method that is effective in pulmonary functions as well as increasing the lung volume radiologically.

Effectiveness and Safety of Preoperative Halo Gravity Traction-Assisted Posterior Spinal Fusion Surgery for Severe and Rigid Scoliosis: A Comparative Matched-Cohort Study

Background. Severe and rigid scoliosis poses significant challenges in surgical correction, and innovative approaches are continually sought to enhance effectiveness and ensure patient safety. Halo-gravity traction (HGT) continues to be a vital tool in managing severe spinal conditions, offering a nonsurgical or preoperative approach to address spinal deformities. However, the correction effect that HGT can achieve for severe and rigid spinal deformity is currently unclear and the impact of HGT on the selection of spinal osteotomy grade was still unknown. Methods. A retrospective matched-cohort study was conducted and a total of 74 patients from January 2018 to December 2021 in our institution were finally enrolled in this study, including 27 patients in the HGT group and 47 patients in the non-HGT group based on whether patients receive HGT or not. Comprehensive assessments including radiographic outcomes, surgical parameters, and clinical complications were collect and analyzed before and after correction surgery. Results. Of the patients included in the HGT group, 21 had thoracic curvature and 6 had thoracolumbar/lumbar curvature, compared with 38 and 9 in the non-HGT group, respectively (P=0.66). There was no significant difference in the etiologies of scoliosis between two groups (15/7/3/2 vs. 25/16/4/2, P=0.85). The main curve in HGT and non-HGT groups were corrected from an average of 113.69°–51.25° and 111.94°–63.79° (P&lt;0.01). For the HGT group, the mean correction rate of focal kyphosis (FK) was 45.43%, which was significantly higher than those in the non-HGT group (33.98%, P&lt;0.05). There were no statistically significant differences in preoperative parameters of sagittal vertical axis (SVA) (P=0.13) or thoracic kyphosis (TK) (P=0.07) between the two groups. Postoperatively, the HGT group showed significantly lower values in SVA (P=0.001) and TK (P=0.001) compared to the non-HGT group. However, there was no significant difference in the imaging parameters coronal vertical axis (CVA) and apical vertebral translation (AVT) between the two groups (P&gt;0.05). In the preoperative surgical planning phase before HGT treatment, 26 patients were initially considered candidates for 3-column osteotomy (3CO), while one patient was evaluated as suitable for posterior column osteotomy (PCO). Following HGT treatment, the assessment changed with 11 patients identified as candidates for 3CO and 16 patients deemed suitable for PCO. The application proportion of 3CO was significantly higher in the non-HGT group than in the HGT group (P&lt;0.05). The mean blood loss of the non-HGT group was significantly greater than that of the HGT group (666.67 ± 486.55 ml vs. 1024.47 ± 718.46 ml, P&lt;0.05), but the surgical time showed no difference between the two groups (297.33 ± 66.89 mins vs. 299.15 ± 56.73 mins, P=0.90). The incidence of complications in the HGT group was 7.4%, which was significantly lower than that of the non-HGT group (P&lt;0.05). Conclusion. This study showed that the use of HGT, as a feasible and safe strategy, has superior efficacy and safety for treating severe and rigid scoliosis and can reduce the level of osteotomy used during surgery to some extent.

Fusion mass to pelvis internal distraction technique using multiple-hook fixation for scoliosis correction: illustrative case.

Internal distraction rods have been described as an alternative to halo gravity traction for the treatment of severe scoliosis. Distraction rods can be challenging to use in patients with existing fusion masses. The authors report an internal distraction, construct-to-construct rod technique using multiple-hook fixation in a patient with a sharply angulated cervicothoracic scoliosis fusion mass. A 12-year-old female with previously diagnosed congenital scoliosis who had undergone cervical fusion in situ at age 2 presented to the clinic with shortness of breath exacerbated by increased levels of activity. Standing anteroposterior and lateral scoliosis radiographs revealed a left >150° cervicothoracic curve, right 140° thoracolumbar curve, and left 28° lumbosacral fractional curve with pelvic obliquity. The authors indicated this patient for a 3-stage all-posterior approach for spinal fusion and deformity correction. In the final fusion surgery, the authors set up a construct-to-construct internal distraction configuration connecting the left hemipelvis to the cervicothoracic fusion mass to aid in deformity correction. A construct-to-construct internal distraction rod technique connecting a fusion mass to the pelvis can assist with curve correction in severe scoliosis.

Safety and effectiveness of halo gravity traction combined with traditional growing rods in severe early-onset scoliosis with neurofibromatosis type 1.

Neurofibromatosis type 1 (NF-1) scoliosis can be difficult to treat without early detection. Correcting deformities while considering long-term growth in early-onset scoliosis (EOS) treatment is important. This study was performed to establish the safety and effectiveness of halo gravity traction (HGT) with traditional growing rods (TGRs) in NF-1 EOS. We retrospectively reviewed a cohort of 15 children (7 boys and 8 girls; mean age, 5.61 years) diagnosed with NF-1 EOS from October 2016 to March 2021. All patients underwent HGT before growing rod implantation. The growing rods were lengthened every 9-12 months, with a follow-up of 2-7 years. Cobb angle, thoracic kyphosis (TK), trunk shift (TS), sagittal vertebral axis and T1-S1 height were measured before operation, after traction, after operation and at last follow-up. Complications were also recorded. Fifteen patients with NF-1 EOS were treated with an average traction weight of 10.00 kg. After 29.20 days of HGT, the Cobb angle improved from 99.10° to 62.60°, TK from 79.33° to 55.04°, TS from 31.05 to 17.71 mm, sagittal vertebral axis from 42.07 to 25.63 mm and T1-S1 height from 27.50 to 29.70 cm (P < 0.05 for all). Postoperatively, compared with post-traction, the Cobb angle was 52.40° (P = 0.002) and TK was 44.54° (P = 0.004). No complications occurred during traction. Growing rod dislocation occurred in one patient and growing rod breakage in one patient. HGT combined with TGRs was well-tolerated and effective for treating severe NF-1 EOS. It significantly corrected the Cobb angle and TK, restored trunk balance, and increased spinal height with few complications.

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

Underprivileged and underserved patients from developing countries often present late with advanced, untreated spinal deformities. We report a three-stage all-posterior approach using limited skeletal traction with Gardner-Wells tongs (GWTs) for the management of severe idiopathic scoliosis during a humanitarian surgical mission trip. A 17-year-old high-school female was previously diagnosed with juvenile idiopathic scoliosis (diagnosed at age 8) and progressed to a severe 135° kyphoscoliosis. Procedural stage 1 involved spinal instrumentation and posterior releases via posterior column osteotomies from T3 to L4. She then underwent 7 days of skeletal traction with GWTs in the intensive care unit as stage 2. In stage 3, rod engagement, posterior spinal fusion, and partial T10 vertebral column resection were performed. There were no changes in intraoperative neuromonitoring during either surgery and she woke up neurologically intact after both stages of the surgical procedure. Skeletal traction with GWTs is a viable alternative to traditional halo-gravity traction in settings with limited resources. Three-stage spinal deformity correction using limited skeletal traction is a feasible and effective approach for managing severe scoliosis during humanitarian surgical mission trips.

Halo-gravity traction combined with growing rod treatment: an effective preoperative management for severe early-onset scoliosis.

The aim of this study was to investigate the effectiveness of preoperative halo-gravity traction (HGT) with subsequent growing rod (GR) treatment in patients with severe early-onset scoliosis (EOS). The authors retrospectively reviewed a cohort of patients with severe EOS who had received preoperative HGT with subsequent GR treatment at their center between January 2008 and January 2020. Patients with a Cobb angle in the coronal or sagittal plane that was > 90° were included. All patients received at least 6 weeks of HGT before GR placement. Results of pulmonary function tests (PFTs) and blood gas tests were compared before and after HGT. Radiological parameters were compared pre-HGT, post-HGT, postindex surgery, and at the latest follow-up. A total of 28 patients (17 boys and 11 girls, mean age 6.1 ± 2.3 years) were included in this study. After a mean of 65.2 ± 22.9 days of traction, the Cobb angle decreased from 101.4° ± 12.5° to 74.5° ± 19.3° (change rate 26.5%), and the kyphosis angle decreased from 71.1° ± 21.2° to 42.7° ± 9.5° (change rate 39.9%). There was a significant improvement in BMI but a decrease in hemoglobin levels following HGT. No HGT-related complications were recorded except pin site infections in 2 patients. Statistically significant improvements in PFTs after HGT were observed in forced vital capacity (FVC) (p = 0.011), the percentage predicted FVC (p = 0.007), FEV1 (p = 0.015), and the percentage predicted forced expiratory volume in 1 second (FEV1) (p = 0.005). Fourteen patients received assisted ventilation due to preoperative hypoxia, alveolar hypoventilation, or hypercapnia. Significant improvement was seen in PaCO2 (p = 0.008), PaO2 (p = 0.005), actual bicarbonate (p = 0.005), and oxygen saturation (p = 0.012) in these patients. After the index surgery, the Cobb angle decreased to 49.5° ± 18.9° and the kyphosis angle decreased to 36.2° ± 25.8°. After a mean of 4.3 ± 1.4 lengthening procedures, the Cobb angle was 56.5° ± 15.8°, and the kyphosis angle was 38.8° ± 19.7°. Surgical complications occurred in 14 (50%) patients, but none of these patients required revision surgery at the latest follow-up. Preoperative HGT notably improved both spinal deformity and pulmonary function in patients with severe EOS. GR treatment after HGT is a safe and effective strategy for these patients.

Thoracic pediculectomy for acute spinal cord decompression in high-risk spinal deformity correction: illustrative case.

Neurological complications are higher in patients with severe spinal deformities (Cobb angle >100°). The authors highlight a known technique for thoracic concave apical pedicle resection that is useful for spinal cord decompression in patients with high-risk spinal deformities in the setting of intraoperative neuromonitoring (IONM) changes. A 14-year-old female with progressive idiopathic scoliosis presented for evaluation of her clinical deformity. Scoliosis radiographs showed a double major curve pattern comprising a 107° right main thoracic curve and a compensatory 88° left thoracolumbar curve. She underwent 2 weeks of halo-gravity traction that reduced her major thoracic curve to 72°. During thoracic posterior column osteotomies, the authors were alerted to decreases in IONM signals that were not responsive to increases in mean arterial pressure, traction weight reduction, and convex compression maneuvers. The dural surface was tightly draped over the two thoracic apical pedicles of T7 and T8, so emergent pediculectomies were performed at both levels for spinal cord decompression. IONM signals gradually improved and eventually became even better than baseline. The patient woke up without any neurological deficits. Pediculectomy of the concave apical pedicle(s) should be considered for spinal cord decompression if there are IONM changes during high-risk spinal deformity surgery.

No Benefits in Using Magnetically Controlled Growing Rod as Temporary Internal Distraction Device in Staged Surgical Procedure for Management of Severe and Neglected Scoliosis in Adolescents.

Severe spinal curvatures (SSCs) in children and adolescents have long been treated with preoperative Halo traction, in its various variations. There are also several radical techniques available for the management of neglected SSCs, such as osteotomies; however, these can be risky. Comparing the treatment outcomes when using preoperative Halo Gravity Traction (HGT) against the use of a Magnetically Controlled Growing Rod (MCGR) as a temporary internal distraction (TID) device, we evaluated the differences in surgical and radiological outcomes. We conducted a retrospective study of 30 patients with SSCs, treated with HGT followed by posterior spinal fusion (PSF; Group 1, n = 18) or treated using a temporary MCGR as a TID followed by PSF (Group 2, n = 12). All patients underwent surgical treatment between 2016 and 2022. The inclusion criteria were SSC > 90°, flexibility < 30%, and the use of preoperative HGT followed by PSF or the two-stage surgical procedure with initial TID rod placement (Stage 1) followed by PSF (Stage 2). The evaluated parameters were as follows: rib hump, trunk height, and radiographic outcomes. All parameters were collected preoperatively, after the initial surgery, after final correction and fusion, and during the final follow-up. In Group 1, we evaluated 18 patients with a mean age of 15.5 years; in Group 2, we evaluated 12 patients with a mean age of 14.2 years. The interval between the staged procedures averaged 32.7 days. The mean preoperative main curves (MC) were 118° and 112° in Group 1 and Group 2, respectively. After definitive surgery, the MC was corrected to 42° and 44° in G1 and G2, respectively. The mean percentage correction of the MC was similar in both groups (65% vs. 61% in G1 and G2, respectively). The mean preoperative thoracic kyphosis was 92.5° in G1 and 98° in G2, corrected to 43.8° in G1 and 38.8° in G2. Trunk height increased by 9 cm on average. There are no benefits in using a MCGR as a temporary internal distraction device in the management of neglected scoliosis in adolescents. Surgical treatment of severe scoliosis may be safe, with a reduced risk of potential complications, when using preoperative HGT. A specific intraoperative complication when using a MCGR as a temporary internal distraction device was a 50% risk of transient neuromonitoring changes, due to significant force applied to the spine and radical distraction of the spine. We achieved similar clinical, radiographic, and pulmonary function outcomes for both techniques. The use of HGT causes less blood loss with a shorter overall time under anesthesia. Partial correction significantly aids the subsequent operation by facilitating a gradual reduction in the curvature, thereby reducing the difficulty of surgical treatment and the risk of neurological deficits.

Surgical management of Hirayama disease in a pediatric patient presenting with severe cervical kyphosis and focal myelopathy: illustrative case.

Hirayama disease (HD) is a rare, nonfamilial neuromuscular disease causing cervical myelopathy and deformity, most commonly effecting pubertal Asian males. Patients whose nonoperative treatment fails and who cannot tolerate long-term cervical immobilization, experience relapse after arrest of symptoms, or present with severe features warrant surgical treatment. Here, the authors present an unusual case of HD that resulted in rapid progression of severe cervical kyphosis and discuss surgical management strategies. A 15-year-old male presented with unprovoked neck pain, progressive chin-on-chest phenomenon, and cervical myelopathy. Imaging revealed a severe subaxial cervical kyphosis of 88° and severe spinal cord compression secondary to changes within the thecal sac, ligaments, and bony elements. He underwent a multistage surgery involving halo gravity traction, C3-6 anterior cervical discectomy and fusion, and C2 to T2 posterior instrumented fusion with C3-5 Smith-Petersen osteotomies. Cervical subaxial pedicle screws facilitated deformity correction through a cantilever technique. HD is rare and often self-limited. For severe or refractory cases of HD, guidelines for surgical management have been suggested, with a variety of approaches deemed efficacious. This is the first case of a patient presenting with such severe cervical deformity; early diagnosis and recognition is the first step toward prompt, adequate management.

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

Halo-gravity traction (HGT) is a well-established technique for correcting severe spinal deformity in pediatric patients. HGT induces soft-tissue relaxation and gradually lengthens the spine, and it can be used preoperatively and intraoperatively. It is typically indicated for spinal deformity over 90° in any plane and medical optimization. There are several complications associated with the use of HGT, and it is critical to follow a protocol and perform serial examinations to minimize this risk.

Preoperative Halo-Gravity Traction for Severe Pediatric Spinal Deformity: Can it Replace a Vertebral Column Resection?

Background: While vertebral column resections (VCRs) are an effective means for correcting severe spine deformities, these complex procedures are associated with high rates of complications. We hypothesized that preoperative halo-gravity traction (HGT) followed by spinal fusion without VCRs can produce equivalent outcomes with less risk than a VCR in complex pediatric spinal deformity.Methods: This was a retrospective review of prospectively collected data of pediatric patients who underwent spinal fusion for severe spinal deformity. Patients treated with either 1) preoperative HGT without VCRs or 2) VCRs without preoperative HGT were included. Patients with congenital etiology and those with prior surgery were excluded. Comparisons were made between cohorts with respect to preoperative, intraoperative, and postoperative (2 years) demographic, radiographic, and health-related quality of life (HRQoL) variables. The rate of revision surgery and any treatment complications were also compared.Results: We identified 49 patients (mean age 16+2.9 years; 54% males) who underwent VCR (17/49; 35%) or preoperative HGT (32/49; 65%) for severe spinal deformities. Those in the HGT cohort had more severe deformity at baseline based on radiographic variables, including maximum Cobb angle, maximum kyphosis, major coronal Cobb angle, and apical vertebral translation. They also had greater residual deformities at 2 years postoperatively, though percent correction of the major deformity magnitude (p=0.28), major (p=0.54) and minor (p=0.91) coronal curve, and apical vertebral translation (p=0.66) was similar to the VCR cohort. Operative time (p=.18), estimated blood loss (0.37), hospitalization length (0.52), and ICU stay (0.12) were similar between cohorts, though patients who underwent VCR had higher rates of total complications (47% vs. 3%; p<0.01). There were no significant differences between cohorts with respect to percent change in HRQoL outcomes from baseline to 2 years postoperatively.Conclusion: Our study suggests that in patients without congenital deformities undergoing primary deformity correction, preoperative HGT followed by spinal fusion produces radiographic outcomes that are similar to VCRs with fewer perioperative complications. Thus, preoperative HGT for severe pediatric deformities may lessen the need to perform higher risk VCRs.Level of Evidence: Level IIIKey Concepts•This study aimed to determine the impact that preoperative halo-gravity traction (HGT) followed by a spinal fusion without vertebral column resection (VCR) has on patients with complex pediatric spinal deformities.•Compared to patients treated with VCR, patients in the HGT cohort experienced similar deformity correction, fewer total perioperative complications, and similar improvements in HRQoL scores 2 years postoperatively.•VCR may increase the risk of perioperative complications relative to management of severe deformities with HGT.

Pre-operative Halo-gravity Traction in the Treatment of Complex Spinal Deformities

Spinal deformity surgeries are complex procedures associated with a high risk of complications. Halo-gravity traction (HGT) is a useful option that provides a gradual traction force to aid in deformity correction. Though its benefits are well-acknowledged, there still exist major ambiguities regarding its role in the management of complex spinal deformities. We performed a systematic review of the electronic databases including EMBASE, MEDLINE, PubMed, and Cochrane on November 12, 2021 to identify relevant articles on HGT; to analyze the existing literature on pre-operative HGT; and to compare the existing protocols for HGT in spinal deformity patients, its varied effects on the radiological parameters and general health status of the patients, and its associated complications. Among the 284 articles available in the literature, 34 articles were finally included and a total of 1151 patients [mean age, 14.6 years] were analyzed. Mean pre-traction coronal Cobb angle of 107° (72°–140.7°) was reduced by 24.8% [to a mean of 80.5° (42°–120.2°)] following HGT. Mean pre- and post-traction sagittal Cobb angles were 88° (56°–134.7°) and 65.4° (36°–113°; a reduction by 25.7%), respectively. Following HGT, mean body weight and body mass index (BMI) of patients improved by 7.2% and 9.1%, respectively. Mean improvement in forced vital capacity and forced expiratory volume has been reported to be 14.5% and 13.9%, respectively. Pre-operative HGT is a useful option in the treatment of spinal deformities. It aids in reducing curve magnitude and provides optimal time for improving general condition (pulmonary and nutritional status) of patients pre-operatively. It is a safe procedure with 2.1% neurological and 11.6% non-neurological complication rates.

The Effect of Halo Gravity Traction Application on Trunk Visual Perception in Severe and Rigid Kyphoscoliosis Patients

The Effect of Halo Gravity Traction Application on Trunk Visual Perception in Severe and Rigid Kyphoscoliosis Patients

The use of the apparatus of an intelligent system with biofeedback in the evaluation of preoperative preparation of a patient with type I diastematomyelia: clinical case

BACKGROUND: Diastematomyelia is a rare congenital anomaly of the spinal cord, characterized by its cleavage in the spinal canal, which can be combined with spinal deformity. When correcting scoliotic deformity, patients with this anomaly have a high risk of developing neurological disorders due to its fixation. Therefore, its preliminary mobilization surgically is necessary. In the upcoming corrective surgery, an important role is also played by preoperative halo-traction training in combination with therapeutic physical culture.&#x0D; CLINICAL CASE DESCRIPTION: A clinical case of the use of the Tergumed 3D intelligent biofeedback system in assessing the effectiveness of preoperative halo-gravity traction in combination with mobilizing therapeutic physical culture in a patient with complex spinal deformity against the background of congenital malformation (type I diastematomyelia) to prepare for surgical correction is presented.&#x0D; CONCLUSION: The results of this study suggest that the combination of physical therapy and halo-traction can be effectively used for preoperative preparation of patients with rigid scoliotic deformities and spinal anomalies. It help analyze preoperative preparation in patients with congenital spinal deformities.

Treatment of Severe Congenital Scoliosis with Type ІI Respiratory Failure.

We report a case of a 14-year girl with severe congenital scoliosis (CS) and type ІІ respiratory failure (RF), who underwent preoperative halo-gravity traction in combination with intraoperative orthopaedic surgery on the spine based on the results of physical examination, pulmonary function tests (PFTs), computed tomography (CT), and blood gas analysis. The patient's coronal and sagittal Cobb's angles changed from 100° to 45° and 40°, respectively, and RF changed from type ІІ to type І after treatment. Scoliosis was corrected well, and RF was improved. During follow-up for nearly 3 years, no loss of deformity correction and no serious complications occurred, and the patient showed a good clinical outcome and balanced spine. Key Words: Congenital scoliosis, Halo-gravity traction, Respiratory failure.

Evaluation of outpatient halo-gravity traction in patients with severe scoliosis: development of a monitoring device.

Patients with severe spinal deformities represent a major clinical and surgical challenge. Halo-gravity traction (HGT) is a traditional method to correct the deformity prior to surgery. Typically, children undergoing HGT remain in the hospital until surgery. Therefore, it has been suggested to treat these children at lower level healthcare centers or even at home. The aim of this study was to develop a tool to assess patient adherence to HGT together with a program to analyze traction results. An original recording system was designed with an Arduino Nano®. The data extracted from the memory card were compiled into a text file and then analyzed with the MatLab R2018a MathWorks®. Five patients receiving HGT for severe scoliosis were asked to use the device both in the wheelchair and in bed to evaluate its usefulness. A device was developed to monitor the use of HGT at home. The device provides information on the time of HGT use and the traction weight placed throughout the day, as well as on the correct functioning of the system in bed and in the wheelchair.