• Anthony Rinella, Lawrence Lenke, Camden Whitaker, Yongjung Kim, Soo-sung Park, Michael Peelle, Charles Edwards, and Keith Bridwell.
• Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA.
• Spine. 2005 Feb 15;30(4):475-82.

Study DesignA retrospective analysis of patients that underwent perioperative halo-gravity traction as an adjunct to modern instrumentation methods in the treatment of severe scoliosis and kyphosis.ObjectiveTo review the clinical and radiographic results of perioperative halo-gravity traction in several time periods.Summary Of Background DataFew reports to our knowledge review the use of perioperative and intraoperative halo-gravity traction in this patient population.MethodsA total of 33 patients with severe operative scoliosis, kyphoscoliosis, or kyphosis were studied based on hospital records, standing pretreatment, traction (before anterior/posterior fusion), postoperative (each stage), and final radiographs. Patients were analyzed by age at date of examination (range, 2-20 years; mean, 13.8 years), gender (18 male, 15 female), major coronal curve magnitude (range, 22 degrees-158 degrees; average, 84 degrees), major compensatory coronal curve magnitude (range, 8 degrees-123 degrees; average, 51 degrees), major sagittal curve magnitude (range, 13 degrees-143 degrees; average, 78 degrees), traction protocol, and procedure type. Halo-traction-related, short- and long-term complications were noted in each case.ResultsThe major coronal curve reduced 38 degrees or 46% after posterior spinal fusion compared to pretreatment radiographs. At an average of 44 months radiographic follow-up (range, 24-107 months), the loss of correction averaged 7 degrees for major coronal curves and 4 degrees of thoracic kyphosis. Clinical complications were noted in the perioperative and long-term time periods.ConclusionsThe treatment of severe scoliosis can be very challenging despite the benefits of modern instrumentation methods, especially if there is a significant kyphosis or a history of intraspinal pathology. Halo-gravity traction is a safe, well-tolerated method of applying gradual, sustained traction to maximize postoperative correction in this difficult population. There were no permanent neurologic deficits in this series.

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