Halogravity traction in the preoperative treatment of scoliosis in twins with Marfan syndrome

Abstract

We report on the influence of the duration of halogravity traction for achieving curve correction in monozygotic twins with Marfan syndrome who underwent posterior spinal fusion. Review of the medical charts and standard radiograph analysis of twin girls treated at our department was performed. Halogravity traction with a four-pin skull construct was applied for 3 weeks in twin A and for 2 weeks in twin B with a maximum of 20% body weight used. Both were on a 24-hours-day halogravity traction regime. Achieved thoracic curve correction after halogravity traction was 31% in twin A and 18% in twin B. Although less curve correction after traction was achieved in twin B, this had no significant implications on final postoperative curve correction. Halogravity traction can be a useful tool in the preoperative treatment of scoliosis in patients with Marfan syndrome if applied for 3 weeks. In order to avoid complications, we propose that lower weights be used with a starting weight of 1.5 kg increased by 1 kg daily until 20% body weight is reached.

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

“…Patients typically reach goal weight within 2 to 3 weeks of initiation and tolerate at least 10 to 12 hours of upright traction during the day 3,4 . However, it is possible to maintain a 24-hour per day traction regime with a HGT bed, wheelchair, and walker frame 27 . When in bed, it should be noted that the bed tilt will provide countertraction.…”

“…Application of traction can begin as early as the day of surgery, with initial weights ranging from 1 lb (0.45 kg) in young children to 2.5 to 5 kg in children closer to maturity 4,22,25,26 . Weight is increased by 1 to 3 lbs per day, up to a goal weight of 33% to 50% of patient body weight 4,26,27 . In our practice, we typically increase weight by 1 lb 3 times a day (total of 3 lbs per day) to allow for a gentle increase and assessment of neurologic examination.…”