Preoperative halo-gravity traction for severe spinal deformities at an SRS-GOP site in West Africa: Protocols, complications, and results

Study Design: 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. Summary of Background Data: 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 healthrelated 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. Conclusion: 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.