The Use and Complications of Halo Gravity Traction in Children with Scoliosis

Abstract

Scoliosis is one of the most frequent spine deformities encountered in children and is regularly discovered after 15 years of age with a girls to boys ratio of 2:1. Vertebral arthrodesis involves both short and long term complications. Neurological complications consist of nerve root injuries, cauda equina or spinal cord deficit. Traction is a good orthopaedic technique of progressive deformity correction which attempts to minimize complications. The purpose of this study is to assess the complications that arise during halo gravity traction and to evaluate the correction of the scoliotic curves under traction. A single centre prospective study was conducted on 19 paediatric patients suffering from scoliosis that were admitted between 2019–2022. Traction-related complications were encountered in 94.7% of patients, with the most frequent being cervical pain (89.5%). It was followed by back pain, in 36.8% of the cases, with just 5.3% of the cases having experienced vertigo or pin displacement. Neurological symptoms were present in 26.3% of the patients and pin pain and pin infection equally affected 26.3% of patients. Even though minor halo related complications are frequent, with proper patient monitoring they can be addressed, thus making traction a safe method for progressive curve correction.

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

“…This reduces the amount of correctional force required during surgery, thus minimizing the risk of surgical complications. 12 , 13 Other benefits of HGT include improved pulmonary function and nutritional status of the patient. 4 , 14 , 15 The increased nutritional status is most beneficial for patients who are underweight preoperatively and risk developing issues with wound care and instrumentation prominence later in their postoperative course.…”

Surgical Treatment of Spinal Deformities in Pediatric Orthopedic Patients

“…Preoperative halo-gravity traction (HGT) has been extensively employed in the clinical treatment of severe deformities, including instances of scoliosis characterized by a Cobb angle > 90° to 100° [ 71 ]. Initially reported by O’Brien et al in 1971 for the treatment of scoliosis [ 72 ], this technique involves the application of a surgically fixed halo and can be performed as either halo-gravity traction or halo-pelvic traction [ 73 , 74 ]. Traction enables a gradual correction of the curve in the frontal, sagittal, or axial plane while facilitating continuous and conscious neurological monitoring.…”

“…Certain conditions, such as cranial malformations that prevent proper pin placement, osteogenesis imperfecta (considered a relative contraindication), and osteoporosis (addressed by using a higher number of pins tightened at a lower torque) may prohibit its use. Absolute contraindications include the presence of intra or extradural growths, medullary canal stenosis, and neurological deficits [ 73 ]. Common complications, such as cervical and back pain, headache, and vertigo, often result from high traction force and can usually be relieved by a reduction in weight.…”

“…Common complications, such as cervical and back pain, headache, and vertigo, often result from high traction force and can usually be relieved by a reduction in weight. Pin complications, including pin pain, infections, and displacement, as well as more severe complications such as deep infections and neurological issues, are relatively rare but must be closely monitored [ 73 ]. Despite these challenges, a careful monitoring of patients can ensure most complications are addressed effectively with minimal adverse outcomes [ 74 ].…”

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

“… 2 , 3 Internal distraction can also serve as an alternative or adjunct to halo gravity traction (HGT), ameliorating the need for an inpatient hospital stay and circumventing common complications of neck pain, pin pain, pin infections, or other neurological sequelae. 4 Previous studies have described a multiple-hook technique as a method for fixating a multilevel fusion mass in revision spinal deformity surgery. 5 We report a construct-to-construct internal distraction rod technique using multiple-hook fixation in a patient with a sharply angulated cervicothoracic scoliosis fusion mass.…”