title: Perioperative halo-gravity traction in the treatment of severe scoliosis and kyphosis.
abstract: METHODS
  A 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.
  
  
  OBJECTIVE
  To review the clinical and radiographic results of perioperative halo-gravity traction in several time periods.
  
  
  BACKGROUND
  Few reports to our knowledge review the use of perioperative and intraoperative halo-gravity traction in this patient population.
  
  
  METHODS
  A 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.
  
  
  RESULTS
  The 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.
  
  
  CONCLUSIONS
  The 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.
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Rinella
authors.forename: Lawrence
authors.initials: L
authors.lastname: Lenke
authors.forename: Camden
authors.initials: C
authors.lastname: Whitaker
authors.forename: Yongjung
authors.initials: Y
authors.lastname: Kim
authors.forename: Soo-sung
authors.initials: SS
authors.lastname: Park
authors.forename: Michael
authors.initials: M
authors.lastname: Peelle
authors.forename: Charles
authors.initials: C
authors.lastname: Edwards
authors.forename: Charles
authors.initials: C
authors.lastname: Edwards
authors.forename: Keith
authors.initials: K
authors.lastname: Bridwell
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007738:Kyphosis / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D019990:Perioperative Care / Q000379:methods* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012600:Scoliosis / Q000453:epidemiology / Q000628:therapy*; D014143:Traction / Q000379:methods* / Q000706:statistics & numerical data