Skip to main content
SpringerLink
Log in

Preoperative halo-gravity traction for treatment of severe adult kyphosis and scoliosis

  • Case Series
  • Published:
Spine Deformity Aims and scope Submit manuscript

Abstract

Study design

Retrospective case series.

Objective

To assess the efficacy of preoperative halo-gravity traction (HGT) in the treatment for severe adult kyphosis and scoliosis.

Summary of background data

Preoperative HGT improves severe curve magnitude and clinical condition in pediatric spinal deformity. However, the efficacy of HGT on severe adult spinal deformity has rarely been studied.

Materials and methods

This study included 18 patients with severe adult kyphosis and scoliosis (age ≥ 18) who underwent a preoperative HGT (mean 4 weeks), and subsequent definitive posterior-alone corrective fusion. Etiologies were neurofibromatosis (n = 5), adult idiopathic (n = 3), multiple vertebral fractures due to osteoporosis (n = 1) and multiple myeloma (n = 1), degenerative failed back syndrome (n = 1), Scheuermann kyphosis (n = 1), Marfan syndrome (n = 1), and other genetic and connective tissue disorders (n = 5). We reviewed baseline demographics, including coronal and sagittal radiographic profiles. The changes in major curve magnitude, pulmonary function tests (PFTs), and nutritional status were assessed between pre- and post-traction and immediate post-definitive corrective surgery.

Results

There were 11 male and 7 female patients, aged 18–69 years with their major coronal and sagittal curves being 92.0° ± 25.2° and 111.6° ± 40.1°, respectively. The major coronal and sagittal curves were reduced by 18.4% and 16.8% after halo-traction, and 54.7% and 44.2% after definitive fusion, respectively. PFTs showed significant increase in %FEV1 and %FVC when comparing pre- and post-traction [43.0% ± 17.4% vs. 49.6% ± 18.7%, and 44.8%. ± 16.7% vs. 54.3% ± 20.7%, respectively, p < 0.01 (n = 11)]. Effective weight gain was observed after traction (46.8 ± 14.5 vs. 49.3 ± 13.5 kg, p < 0.01).

Conclusion

Halo-gravity traction (HGT) for severe coronal and sagittal plane spinal deformity in adult patients significantly reduced Cobb angles, improved PFTs, and allowed for effective weight gain in the preoperative period. The use of preoperative HGT is extremely beneficial to optimize the alignment and overall health of severe adult spinal deformity patients before their spinal reconstruction.

Level of evidence

Level IV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

References

  1. Tredwell SJ, O'Brien JP (1980) Apophyseal joint degeneration in the cervical spine following halo-pelvic distraction. Spine 5:497–501

    Article  CAS  Google Scholar 

  2. Takeshita K, Lenke LG, Bridwell KH et al (2006) Analysis of patients with nonambulatory neuromuscular scoliosis surgically treated to the pelvis with intraoperative halo-femoral traction. Spine 31:2381–2385

    Article  Google Scholar 

  3. Nemani VM, Kim HJ, Bjerke-Kroll BT et al (2015) Preoperative halo-gravity traction for severe spinal deformities at an SRS-GOP site in West Africa: protocols, complications, and results. Spine 40:153–161

    Article  Google Scholar 

  4. Yang C, Wang H, Zheng Z et al (2017) Halo-gravity traction in the treatment of severe spinal deformity: a systematic review and meta-analysis. Eur Spine J 26:1810–1816

    Article  Google Scholar 

  5. Sponseller PD, Takenaga RK, Newton P et al (2008) The use of traction in the treatment of severe spinal deformity. Spine 33:2305–2309

    Article  Google Scholar 

  6. Koller H, Zenner J, Gajic V et al (2012) The impact of halo-gravity traction on curve rigidity and pulmonary function in the treatment of severe and rigid scoliosis and kyphoscoliosis: a clinical study and narrative review of the literature. Eur Spine J 21:514–529

    Article  Google Scholar 

  7. Protopsaltis T, Schwab F, Bronsard N et al (2014) The T1 pelvic angle, a novel radiographic measure of global sagittal deformity, accounts for both spinal inclination and pelvic tilt and correlates with health-related quality of life. J Bone Joint Surg Am 96:1631–1640

    Article  Google Scholar 

  8. Bogunovic L, Lenke LG, Bridwell KH et al (2013) Preoperative halo-gravity traction for severe pediatric spinal deformity: complications, radiographic correction and changes in pulmonary function. Spine Deform 1:33–39

    Article  Google Scholar 

  9. Janus GJ, Finidori G, Engelbert RH et al (2000) Operative treatment of severe scoliosis in osteogenesis imperfecta: results of 20 patients after halo traction and posterior spondylodesis with instrumentation. Eur Spine J 9:486–491

    Article  CAS  Google Scholar 

  10. Sink EL, Karol LA, Sanders J et al (2001) Efficacy of perioperative halo-gravity traction in the treatment of severe scoliosis in children. J Pediatr Orthop 21:519–524

    CAS  PubMed  Google Scholar 

  11. Bouchoucha S, Khelifi A, Saied W et al (2011) Progressive correction of severe spinal deformities with halo-gravity traction. Acta Orthop Belg 77:529–534

    PubMed  Google Scholar 

  12. Caubet JF, Emans JB (2011) Halo-gravity traction versus surgical release before implantation of expandable spinal devices: a comparison of results and complications in early-onset spinal deformity. J Spinal Disord Tech 24:99–104

    Article  Google Scholar 

  13. Watanabe K, Lenke LG, Bridwell KH et al (2010) Efficacy of perioperative halo-gravity traction for treatment of severe scoliosis (≥ 100 degrees). J Orthop Sci 15:720–730

    Article  Google Scholar 

  14. Park DK, Braaksma B, Hammerberg KW et al (2013) The efficacy of preoperative halo-gravity traction in pediatric spinal deformity the effect of traction duration. J Spinal Disord Tech 26:146–154

    Article  Google Scholar 

  15. Dove J, Hsu LC, Yau AC (1980) The cervical spine after halo-pelvic traction. An analysis of the complications of 83 patients. J Bone Joint Surg Br 62:158–161

  16. Zhang JG, Wang W, Qiu GX et al (2005) The role of preoperative pulmonary function tests in the surgical treatment of scoliosis. Spine 30:218–221

    Article  CAS  Google Scholar 

  17. Brand PL, Quanjer PH, Postma DS, et al. (1992) Interpretation of bronchodilator response in patients with obstructive airways disease. The Dutch Chronic Non-Specific Lung Disease (CNSLD) Study Group. Thorax 47:429–436

  18. Wilkins C, MacEwen GD (1977) Cranial nerve injury from halo traction. Clin Orthop Relat Res 126:106–110

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital At New York Presbyterian, 710 W 168th St, New York, NY, 10032, USA

    Takayoshi Shimizu, Lawrence G. Lenke, Meghan Cerpa, Ronald A. Lehman Jr, Suthipas Pongmanee & J. Alex Sielatycki

  2. Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan

    Takayoshi Shimizu

Authors
  1. Takayoshi Shimizu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lawrence G. Lenke
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Meghan Cerpa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ronald A. Lehman Jr
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Suthipas Pongmanee
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. Alex Sielatycki
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lawrence G. Lenke.

Ethics declarations

Conflict of interest

TS (none), LGL (personal fees from Medtronic; grants and personal fees from DePuy-Synthes Spine; personal fees from K2M; nonfinancial support from Broadwater, Seattle Science Foundation, Stryker Spine, and The Spinal Research Foundation; grants and nonfinancial support from Scoliosis Research Society; grants from EOS and Setting Scoliosis Straight Foundation; personal fees from Fox Rothschild, LLC, and Quality Medical Publishing; other from Evans Family Donation and Fox Family Foundation; grants and nonfinancial support from AOSpine, outside the submitted work), MC (none), RAL (other from Medtronic, Stryker, and DePuy-Synthes Spine, outside the submitted work), SP (none), JAS (none).

IRB approval

This study was approved by the institutional review board of Columbia University.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shimizu, T., Lenke, L.G., Cerpa, M. et al. Preoperative halo-gravity traction for treatment of severe adult kyphosis and scoliosis. Spine Deform 8, 85–95 (2020). https://doi.org/10.1007/s43390-019-00017-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s43390-019-00017-z

Keywords

Search

Navigation