The Use of Halo Gravity Traction in the Treatment of Severe Early Onset Spinal Deformity

Authors

• Sravisht Iyer, Hospital for Special Surgery - New York
• Henry Ofori Duah, Marquette UniversityFollow
• Irene Wulff, FOCOS Orthopaedic Hospital
• Henry O. Tutu, FOCOS Orthopaedic Hospital
• Rufai Mahmud, FOCOS Orthopaedic Hospital, Accra, Ghana
• Kwadwo P. Yankey, FOCOS Orthopaedic Hospital
• Harry Akoto, Korle-Bu Teaching Hospital
• Oheneba Boachie-Adjei, FOCOS Orthopaedic Hospital

Document Type

Article

Publication Date

7-2019

Publisher

Lippincott Williams & Wilkins, Inc.

Source Publication

Spine

Source ISSN

0362-2436

Abstract

Study Design. 

Retrospective Review of Prospective cohort.

Objective. 

To describe the feasibility of preoperative halo gravity traction (HGT) with subsequent growing rod/guided growth (GR/GG) placement in early onset spinal deformity (EOSD).

Summary of Background Data. 

In children with severe EOSD, primary implantation of GR/GG constructs is not always possible. We describe a staged protocol with preoperative HGT followed by GR/GG implantation.

Methods. 

EOSD patients treated with HGT prior to GR/GG implantation were included. HGT used traction up to 50% body weight for 4 to 29 weeks. Pulmonary function tests (PFTs) were performed before and after HGT. Coronal Cobb (CC) and Sagittal Cobb (SC) angles were measured on the Pre-HGT, Post-HGT and 6 week postop x-rays.

Results. 

Thirty patients were included. Average age at GR/GG implantation was 9 years. Most cases (n = 24, 80%) were idiopathic. Most pts had kyphoscoliosis (n = 16, 53.3%). Pre-HGT CC averaged 112 ± 22° and SC averaged 106 ± 26°. CC and SC improved 29% after HGT. There was a significant improvement in body mass index following HGT. CC improved further to 70 ± 14° (36% vs. pre-HGT) and SC to 63 ± 21° (41%) with GR/GG placement. HGT-related complications occurred in nine patients (30%); eight pin site infections, one cranial abscess. Most HGT complications were managed with local pin care and oral antibiotics. Halo revision was required in two pts (6.7%). There was no change in PFTs with HGT (P > 0.05). Averagely, 14 levels were spanned during GR/GG implantation; two patients required vertebral column resection. Surgical complications occurred in nine (30%) patients. At average 16 month follow-up, seven patients (23.3%) required reoperation.

Conclusion. 

Preoperative HGT can make severe EOSD curves amenable to GR/GG implantation. HGT results in ∼30% correction with improvement to ∼35–40% following GR/GG. HGT has a 30% complication rate but most are pin-site infections managed with pin-site care and oral antibiotics; 6.7% of patients require revision.

Comments

Accepted version. Spine, Vol. 44, No. 14 (2019): E841-E845. DOI. This article is © 2019 Wolters Kluwer Health, Inc. Used with permission.

Henry Duah was affiliated with FOCOS Orthopaedic Hospital, Accra, Ghana at the time of publication.

Recommended Citation

Iyer, Sravisht; Duah, Henry Ofori; Wulff, Irene; Tutu, Henry O.; Mahmud, Rufai; Yankey, Kwadwo P.; Akoto, Harry; and Boachie-Adjei, Oheneba, "The Use of Halo Gravity Traction in the Treatment of Severe Early Onset Spinal Deformity" (2019). College of Nursing Faculty Research and Publications. 1241.
https://epublications.marquette.edu/nursing_fac/1241