Halo-Pelvic Traction in Severe Adult Spinal Deformity: A Systematic Review and Meta-Analysis.

Abstract

Background: Severe adult spinal deformity remains a challenging condition to treat, particularly in patients with rigid curves and limited physiological reserve. Halo-pelvic traction (HPT), historically regarded as a transformative technique, has declined in use but continues to be applied in selected cases. This updated systematic review and meta-analysis aims to clarify the efficacy and safety of HPT in adults.

Methods: A systematic search of PubMed, Cochrane, Scopus, Wiley, and Proquest was conducted. Eligible studies included adult patients with severe spinal deformity managed with HPT, alone or in combination with surgery. Primary outcomes were radiographic correction (Cobb angle, kyphotic angle). Secondary outcomes included functional scores, pain improvement, and perioperative parameters. Risk of bias was assessed with ROBINS-I, and certainty of evidence was evaluated using GRADE.

Results: Ten retrospective studies were included. Pooled analysis demonstrated significant radiographic correction, with a mean Cobb angle reduction of 55.46° and a kyphotic angle reduction of 53.49°. Subgroup analyses showed the greatest corrections in postoperative HPT (71.41° for Cobb, 120.00° for kyphosis). Functional outcomes (MD 0.57, p = 0.168) and pain outcomes (MD 0.47, p = 0.331) did not show significant improvements. Complications included pin site infections, cranial nerve irritation, and pelvic discomfort. Heterogeneity was high across outcomes.

Conclusion: HPT achieves powerful radiological correction in severe adult spinal deformity, particularly when used preoperatively before definitive surgery. However, functional and pain outcomes remain inconsistent, and the technique carries notable burdens and complications. Its role in modern practice should be individualized, and high-quality prospective studies are needed.