title: Halo-gravity traction in the treatment of severe spinal deformity: a systematic review and meta-analysis.
abstract: Halo-gravity traction has been reported to successfully assist in managing severe spinal deformity. This is a systematic review of all studies on halo-gravity traction in the treatment of spinal deformity to provide information for clinical practice.
  
  
  
  A comprehensive search was conducted for articles on halo-gravity traction in the treatment of spinal deformity according to the PRISMA guidelines. Appropriate studies would be included and analyzed. Preoperative correction rate of spinal deformity, change of pulmonary function and prevalence of complications were the main measurements.
  
  
  
  Sixteen studies, a total of 351 patients, were included in this review. Generally, the initial Cobb angle was 101.1° in the coronal plane and 80.5° in the sagittal plane, and it was corrected to 49.4° and 56.0° after final spinal fusion. The preoperative correction due to traction alone was 24.1 and 19.3%, respectively. With traction, the flexibility improved 6.1% but postoperatively the patients did not have better correction. Less aggressive procedures and improved pulmonary function were observed in patients with traction. The prevalence of traction-related complications was 22% and three cases of neurologic complication related to traction were noted. The prevalence of total complications related to surgery was 32% and that of neurologic complications was 1%.
  
  
  
  Partial correction could be achieved preoperatively with halo-gravity traction, and it may help decrease aggressive procedures, improve preoperative pulmonary function, and reduce neurologic complications. However, traction could not increase preoperative flexibility or final correction. Traction-related complications, although usually not severe, were not rare.
authors.affiliation: Department of Orthopedic Surgery, Guangdong Orthopedic Hospital (The Third Affiliated Hospital of Southern Medical University), Guangzhou, 510000, China.
authors.forename: Changsheng
authors.initials: C
authors.lastname: Yang
authors.affiliation: Department of Spine Surgery, Fuzhou Second Hospital, Xiamen University, Fuzhou, 350007, China.
authors.forename: Huafeng
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, China. zhengzm1@163.com.
authors.forename: Zhaomin
authors.initials: Z
authors.lastname: Zheng
authors.affiliation: Department of Orthopedic Surgery, Guangdong Orthopedic Hospital (The Third Affiliated Hospital of Southern Medical University), Guangzhou, 510000, China.
authors.forename: Zhongmin
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, China. zzuwjr@163.com.
authors.forename: Jianru
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Liu
authors.affiliation: Department of Orthopaedic Surgery, College of Physicians and Surgeons, Columbia University, 622 West 168th Street PH-11, New York, NY, 10032, USA.
authors.forename: Yongjung Jay
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, Box 1188, New York, NY, 10029, USA.
authors.forename: Samuel
authors.initials: S
authors.lastname: Cho
mesh_terms: D006112:Gravitation; D006801:Humans; D012720:Severity of Illness Index; D013121:Spinal Curvatures / Q000628:therapy*; D014143:Traction / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome
keywords: Complication; Halo-gravity traction; Preoperative correction; Spinal deformity