Study design: Retrospective case review
Objective: To assess the appropriate length of halo-gravity traction that provides the most preoperative correction and minimizes halo associated complications.
Summary of background: Rapid correction of severe scoliosis increases the risk of neurological compromise. To minimize complications, some patients undergo preoperative halo traction providing gradual correction before definitive management. The appropriate length of traction to provide the most preoperative correction is unknown.
Methods: Twenty pediatric patients (age: range, 220 y, average 11.2 y) with severe operative scoliosis, kyphoscoliosis, or kyphosis were retrospectively studied. The major structural coronal curves before traction (n = 11 patients, 19 curves, range 44128 degrees, average 84.7 degrees) or immediately after anterior release (n = 7 patients, 10 curves, range 3598 degrees, average 67.7 degrees) were measured as well as weekly during traction and postoperatively at 1 year. Sagittal kyphosis (n = 12 patients, range 60143 degrees, average 97.6 degrees) was measured at the same time intervals. Patients in traction(maximum traction weight range 15.5% to 46.5% of bodyweight, average 32.9%) for a duration of at least 3 weeks (range 310.5 wk, average 4.6 wk) were included. Patients with prior surgical fusion were excluded; however, patients who under went a stage anterior-posterior were included. Halo-traction related complications were noted in each case.
Results: The major coronal and sagittal curve corrected 66.3% and 62.7% (change in curve per week/total change in curve), respectively at 2 weeks (n = 29, 12 curves), 21.7% and 24.3% at 3 weeks (n = 29, 12), and 7.5% and 15.9% at 4 weeks (n = 14,6). Traction-related complications during the traction duration included 2 cases of ileus, 1 respiratory complication, 2 pin loosening, and 1 superficial pin infection.
Conclusion: The treatment of severe scoliosis can be very challenging. The use of long-term halo traction preoperatively can assist in the surgical correction. The majority of correction occurs during the first 2 weeks of traction. No permanent neurological complications occurred during traction.