Preoperative halo-gravity traction for severe pediatric spinal deformity: Complications, radiographic correction and changes in pulmonary function

Background Summary: The use of preoperative halo-gravity traction (HGT) improves both spinal deformity and pulmonary function and is a helpful adjuvant in the treatment of complex spinal deformity. Despite the benefits of preoperative HGT, there is no consensus on the optimal traction protocol. Methods: We evaluated the treatment of 33 patients treated with preoperative HGT to determine the safety and efficacy of preoperative HGT with regards to deformity correction; to quantify changes in pulmonary function; and to better define an ideal preoperative traction protocol. All patients were treated at the same tertiary-care pediatric hospital between 1998 and 2007. Inclusion criteria were preoperative HGT (before anterior and/or posterior spinal fusion), pretraction spinal Radiographs, repeat Radiographs taken during the traction period, and repeat Radiographs taken at the completion of traction and final Radiographs after surgical correction. The average duration of preoperative HGT was 70.1 days. The average traction weight applied was 38.5% of total body weight. Maximal traction weight was achieved in an average of 30.5 days. Results: Our results, 35% correction of the coronal Cobb and 35% correction of the sagittal Cobb, are consistent with others reported in the literature. Pulmonary function tests taken before and after traction were available for 22 patients. Treatment with HGT improved pulmonary function results in 19 patients. There were no serious complications. Conclusion: We found that preoperative HGT is a safe and useful adjuvant to the treatment of patients with severe scoliosis. Significant deformity correction averaging 35% percent can be expected, with the majority of deformity correction occurring after 3 to 4 weeks. In the majority of patients, this correction is maintained or even improved with subsequent surgical correction.