The Effect of Prolonged Pre-Operative Halo Gravity Traction for Severe Spinal Deformities on the Cervical Spine Radiographs

Study Design: Retrospective review of consecutive series. Objective: The study sought to assess the effect of prolonged pre-operative halo gravity traction (HGT) on the c-spine radiographs Methods: Data of 37 pediatric and adult patients who underwent >= 12wks pre-op HGT prior to definitive spine surgery from 2013-2015 at a single site in West Africa was reviewed. Radiographic assessment of the c-spine including ADI, SVA and C2-C7 Lordosis were done at pre HGT and at 4 weekly intervals. Paired T-Test was performed to evaluate changes in these parameters during HGT. Results: 37pts, 18/19 (F/M). Average age 18.2yrs. Diagnoses: 22 idiopathic, 6 congenital, 3 Post TB, 2 NM and 4 NF. Average duration of HGT: 125 days. Baseline coronal Cobb:130 deg, corrected 30% in HGT; baseline sagittal Cobb:146 deg, corrected 32% post HGT. Baseline ADI (3.17 +/- 0.63 mm) did not change at 4wks (P > 0.05) but reduced at 8wks (2.80 +/- 0.56 mm) and 12wks (2.67 +/- 0.51 mm) post HGT (P < 0.05). Baseline HGT SVA (20.7 +/- 14.98 mm) significantly improved at 4wks (11.55 +/- 10.26 mm), 8wks (7.54 +/- 6.78 mm) and 12wks (8.88 +/- 4.5 mm) (P < 0.05). Baseline C2-C7 lordosis (43 +/- 20.1 deg) reduced at 4wks (26 +/- 16.37 deg), 8wks (17.8 +/- 14.77 deg) and 12wks (16.7 +/- 11.33 deg) post HGT (P < 0.05). There was no incidence of atlanto-axial instability on flexion extension radiographs at any interval. Conclusion: Prolonged HGT, while providing partial correction of severe spine deformities, also appeared to have no adverse effect on atlanto-axial stability or cervical alignment. Therefore, HGT can be safely applied for several weeks in the preoperative management of severe spine deformities in pediatric/adult patients.

Automated summary

This study evaluated the effect of prolonged pre-operative halo gravity traction (HGT) on c-spine radiographs. The results showed that HGT can partially correct severe spine deformities without adverse effects on atlanto-axial stability or cervical alignment.