Preoperative halo gravity traction (HGT) in severe rigid scoliosis - A single centre study.

BACKGROUND

Managing severe and rigid spinal deformities with limited flexibility and high Cobb angles (≥90°) remains a significant challenge in spine surgery. Halo Gravity Traction (HGT) has been adopted preoperatively to optimize surgical tolerance, facilitate spinal correction, and improve surgical outcomes.

OBJECTIVE

This study aimed to determine the outcomes of severe scoliosis managed by preoperative HGT followed by definitive spinal fusion.

METHODS

A retrospective analysis of 27 patients was conducted at a single center between 2010 and 2023. The inclusion criteria were patients with severe scoliosis or kyphoscoliosis who underwent HGT before definitive spinal fusion, with a minimum 2-year follow-up. The variables collected included age, HGT duration, sex, deformity etiology, preoperative, post-HGT, and postoperative coronal and sagittal Cobb angles, curve flexibility, and complications. Continuous variables were assessed in Microsoft excel and p value was calculated for categorical variables using Paired T Test (p value < 0.05 was taken as significant).

RESULTS

The mean age of the patients was 13.17 years (range, 4-26 years), with an average HGT duration of 40.5 days (SD ± 29.43). The mean preoperative, post-HGT, and postoperative Cobb angles in the 27 patients were 95.18°, 70.46°, and 46.76°, respectively, reflecting a significant postoperative correction rate of 50.87 %. Intraoperative monitoring changes were observed in 18.51 % of the patients. Four (12.5 %) patients had postoperative neuro-deficits, of which three completely recovered. One patient had a neurology of ASIA B in the immediate postoperative period, which improved to AISA D at 2 years of follow-up. The postoperative complications included pin-site infections (14.81 %), wound healing issues (11.11 %), implant prominence (7.40 %), implant failure (14.81 %), and proximal/distal junctional kyphosis (11.11 %).

CONCLUSION

HGT followed by definitive spinal fusion is an effective method for managing severe rigid spinal deformities because HGT can partially correct the deformity and aid in gradual stretching and spinal stress relaxation.