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.
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:
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.
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
Instability of the cervical spine or neck
3.
Patients with increased muscle tone, which
includes most patients with cerebral palsy
Patients with increased muscle tone, which
includes most patients with cerebral palsy
4.
Behavioral issues
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.
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
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.
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.
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.
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.
References:
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
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.
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.