title: Preoperative halo-gravity traction for severe spinal deformities at an SRS-GOP site in West Africa: protocols, complications, and results.
abstract: METHODS
  Retrospective analysis of a prospectively collected single-center database.
  
  
  OBJECTIVE
  We describe a modified halo-gravity traction (HGT) protocol for patients with severe spinal deformities in West Africa, and assess the clinical and radiographic outcomes.
  
  
  BACKGROUND
  Three-column osteotomies are frequently used in the correction of severe spinal deformities; however, these can be associated with high complication rates and significant risk for neurological injury. Preoperative traction is one modality used to obtain a partial correction prior to definitive fusion. Low numbers and variability of traction protocols, however, have limited previous reports of sustained HGT.
  
  
  METHODS
  All patients who underwent HGT in Ghana from April 2012 to August 2013 were reviewed. HGT was started at 20% body weight and increased by 10% per week until 50% body weight was reached by 4 weeks or thereafter as tolerated. Demographic variables, operative data, radiographic parameters, and health-related quality of life scores were collected. A deformity reduction index was calculated at each time point by summing the scoliosis and abnormal kyphosis for each patient and reported as a percentage of the preoperative deformity.
  
  
  RESULTS
  Twenty-nine patients underwent HGT for an average 107 days prior to definitive posterior spinal fusion (24 patients) or placement of growing rods (5 patients). The major curve improved from an average 131° to 90° (31%) after HGT, and to an average 57° (56%) postoperatively. Pure kyphotic curves were rigid (flexibility 22% after traction), with a correction index of 3.88, which is similar to historical controls. Deformity correction with HGT plateaued at 63 days. Overall Scoliosis Research Society-22 questionnaire scores improved significantly pretraction versus postoperatively, but there was no change after traction versus before traction. There were 11 pin tract infections, with no neurological complications.
  
  
  CONCLUSIONS
  HGT is a safe method to partially correct severe spinal deformities prior to a definitive procedure, and may reduce the need for higher risk 3-column osteotomies. Importantly, kyphosis secondary to infection with spontaneous apical ankylosis is relatively resistant to HGT.
  
  
  METHODS
  4.
authors: *Spine and Scoliosis Surgery, Hospital for Special Surgery, New NY †Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan ‡Spine Unit, Hospital Ruber Internacional, Madrid, Spain §Department of Neurosurgery, Korle Bu Teaching Hospital, Accra, Ghana ¶2nd Department of Orthopaedics, University of Athens School of Medicine, Athens, Greece ‖Department of Orthopedic Surgery, Spine Unit, Hospital La Paz, Madrid, Spain **Spine Unit, Servicio de COT, Hospital Vall d'Hebron, Barcelona, Spain ††Research Department, FOCOS Hospital, Accra, Ghana; and ‡‡AJJDC, Addis Ababa, Ethiopia.
authors: Venu M
authors: VM
authors: Nemani
authors: Han Jo
authors: HJ
authors: Kim
authors: Benjamin T
authors: BT
authors: Bjerke-Kroll
authors: Mitsuru
authors: M
authors: Yagi
authors: Cristina
authors: C
authors: Sacramento-Dominguez
authors: Harry
authors: H
authors: Akoto
authors: Elias C
authors: EC
authors: Papadopoulos
authors: Francisco
authors: F
authors: Sanchez-Perez-Grueso
authors: Ferran
authors: F
authors: Pellise
authors: Joseph T
authors: JT
authors: Nguyen
authors: Irene
authors: I
authors: Wulff
authors: Jennifer
authors: J
authors: Ayamga
authors: Rufai
authors: R
authors: Mahmud
authors: Richard M
authors: RM
authors: Hodes
authors: Oheneba
authors: O
authors: Boachie-Adjei
mesh_terms: D000293:Adolescent; D000354:Africa, Western; D002648:Child; D005260:Female; D006112:Gravitation; D006801:Humans; D007738:Kyphosis / Q000601:surgery*; D008297:Male; D009989:Orthotic Devices; D010027:Osteotomy / Q000379:methods*; D011300:Preoperative Care; D012189:Retrospective Studies; D012600:Scoliosis / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods; D014143:Traction / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult