Thursday, April 16, 2020

Halo-Gravity Traction in Spinal Deformity Treatment (Part 2)
To provide a more complete answer from the last blog on “when” we use halo-gravity traction, the answer is: Before spine deformity surgery, at which time growing rods, Shilla Growth Guidance System or a definitive spinal fusion is performed. 

Case: 5 year old male with 101 degree curve. 

 Decreases to 72 degrees after 6 weeks of traction

Patient undergoes T2-L3 Shilla Growth Guidance Procedure after halo-gravity traction treatment.

When should halo-gravity traction not be used?
There are several situations in which we do not use halo-gravity traction:
1.       The halo is attached to the skull by pins.  This means there must be good bone where the pins are placed to provide safe, stable fixation.  Patients with soft bone or defects in their skull like Swiss cheese (such after brain surgery) may not be candidates for halo-gravity traction.

2.       Instability of the cervical spine or neck
3.       Patients with increased muscle tone, which includes most patients with cerebral palsy
4.       Behavioral issues
5.       Patients with spinal cord dysfunction (weakness, pain, sensation problems, bowel/bladder problems) may benefit from preoperative HGT, but each person must be evaluated individually.

Where is the halo placed?
The halo is applied under general anesthesia, which means the patient is completely asleep

Does it hurt?
When the halo is applied local anesthetic (numbing medicine) is injected at the pin sites to decrease the pain for up to 6 hours after halo application.  Pain medication is given through the IV or orally as needed.  Most patients report the pain is like having a headache and the pain usually subsides gradually and is mostly gone after 48 hours.

Why is the traction treatment typically around 6 weeks?
Studies from our hospitals, mainly Shriners Hospital, have demonstrated maximal correction takes up to 6 weeks.  The length of traction depends on many deformity factors which include location, magnitude and flexibility of the spine deformity.

How much weight is applied to the traction?
Typically traction weight starts at 5-10 pound right after surgery.  Weight is added daily until the goal weight is achieved.  Our studies have demonstrated maximal correction of the spine deformity occurs between 35% and 40% of the patient’s body weight.

Where is the halo-gravity traction used?  At home or in the hospital?
At our center we only use HGT while in the hospital.

1.       Bogunovic L, Lenke LG, Bridwell KH, Luhmann, SJ.  Preoperative Halo-Gravity Traction for Severe Pediatric Spinal Deformity: Complications, Radiographic Correction and Changes in Pulmonary Function.  Spine Deformity 2013;1:33-39
2.       Lenke LG, Sugrue PA, Bridwell KH, Kelly MP, Luhmann SJ, Sides BA, Bokshan S, Bumpass DB, Karikari IO, Gum JL:  The radiographic and clinical impact of preoperative halo-gravity traction in the treatment of early-onset spinal deformity.  Spine Deformity 3(6):617-618, 2015.

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