Halo traction evaluation of Cranio-cervical instability in hereditary connective tissue disorder patients: Case series

Abstract

Introduction: Cranio-cervical instability (CCI) is a condition commonly found in patients with connective tissue disorders such as Ehlers-Danlos Syndrome (EDS), leading to various symptoms. Assessing patients for surgical fusion as a treatment for CCI is challenging due to the complex nature of EDS-related symptoms. This study aimed to evaluate the role of pre-fusion Halo traction in alleviating symptoms and determining suitable candidates for fusion surgeries. Methods: A case series of 15 EDS patients with neurological symptoms underwent halo traction between 2019 and 2022. Patients completed a CCI Questionnaire before and after the traction, reporting symptoms related to headache, vision, hearing, equilibrium, and performance. Symptom groups were assigned scores based on patient responses, with one point for each affirmative answer. The scores were statistically analyzed using a paired t-test. Patients experiencing over 50% improvement in the majority of symptoms were considered for fusion surgery, and 7 out of 12 patients subsequently underwent the procedure. Results: The average age of the patients was 38 years, with a female-to-male ratio of 14:1, consistent with existing literature. Significant improvements were observed in various symptom categories after halo traction, including headache (63% improvement, p < 0.001), brainstem functions (72% improvement, p < 0.001), cerebellar functions (59% improvement,p < 0.001), hearing (65% improvement, p < 0.001), motor functions (62% improvement, p < 0.001), vision (53% improvement, p < 0.001), cardiovascular functions (58% improvement, p< 0.05), sensory and pain (56% improvement, p < 0.001), high cortical functions (54% improvement, p < 0.01), GI functions (41% improvement, p < 0.05), bladder functions (55% improvement, p< 0.001), and Modified Karnofsky score (26% improvement, p < 0.05). Conclusion: halo traction proved to be a simple and effective method for both evaluating patients for surgery and providing symptomatic relief in EDS-related CCI cases. It also allows surgeons to monitor patients with stable cranio-cervical junctions before committing to surgery. However, the study's limitations include the small sample size and the absence of a validated questionnaire with a scoring system.