The Use of Halo Gravity Traction in Severe, Stiff Scoliosis.
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2021-07
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Abstract
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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.Type
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Rocos, Brett, Luke Reda, David E Lebel, Michael K Dodds and Reinhard Zeller (2021). The Use of Halo Gravity Traction in Severe, Stiff Scoliosis. Journal of pediatric orthopedics, 41(6). pp. 338–343. 10.1097/bpo.0000000000001830 Retrieved from https://hdl.handle.net/10161/29697.
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Brett Rocos
I joined the team at Duke University Health from London, UK, where I was a Consultant Adult and Paediatric Spine Surgeon at Barts Health NHS Trust and Honorary Consultant Senior Lecturer at Queen Mary University of London. I completed my surgical training in in the South West of the UK and at the University of Toronto, and am fellowship trained in adult spine surgery, paediatric spine surgery, orthopaedic trauma surgery, research and healthcare management.
I am driven to support patients at every stage of their care, from clinic assessment, through surgery to discharge. Making sure that every person, adult, child, family or friend understands what’s wrong, helping them to choose the right treatment for them, and what the recovery will be like is an important priority.
My research activity focusses on finding effective new treatments for spinal disorders and bringing them to patients. Focusing on spinal deformity, I have led investigations in the UK, Canada and the USA, and I sit on the Global AO Knowledge Forum for Deformity and the Research Grants Committee at the Scoliosis Research Society. I have lectured in North America and Europe about the treatment of spine disorders for the Scoliosis Research Society, Global Spine Congress, AO Spine and Eurospine, and I have worked hard to produce research that improves the care for spine patients wherever they live. Lastly, I review for several orthopaedic journals and I am Deputy Editor of the Bone and Joint 360, a leading publication with a global readership.
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