Halo-gravity traction

Halo-gravity traction (HGT) is a safe and effective method to correct early onset scoliosis (EOS) deformity prior to operative management, or as a delaying tactic. It is well tolerated, providing instant patient mobilization in the upright position, and is especially useful in patients with thoracic insufficiency/respiratory impairment and/or nutritional difficulties. Preoperative deformity correction (scoliosis and kyphosis) and thoracic height improvement is typically ~30%, achieving valuable nonoperative correction in patients where osteopenia and rigidity likely will prevent successful acute instrumented correction. Pulmonary function is frequently improved up to 20% from baseline due to improved diaphragmatic excursion, and weight gain occurs from elongation of the abdominal cavity combined with aggressive preoperative management. Contraindications to HGT include insufficient skull bone stock, intra- or extra-medullary space-occupying lesions in the spinal cord, and severe canal distortion with stenosis. Complications of traction include pin track infections in 10-20% of patients, usually managed with pin exchange or oral antibiotics, and neurologic injury in a very small percentage, which may not recover following HGT discontinuation.