Surgical management of 117 patients with halo-gravity traction: corrections, complications, and neurological risks: Surgical management of 117 patients with halo-gravity traction.

Background: Severe scoliosis, defined by a major curve exceeding 80°, requires surgical correction and is particularly prone to post-operative mechanical and neurological complications.

Objective: This study aimed to evaluate the corrections and complications obtained by halo-gravity traction (HGT) followed by single posterior approach surgery for severe scoliosis. The secondary objective was to identify any risk factors associated with neurological complications.

Methods: A single-center retrospective review of all patients operated on with severe scoliosis or kyphosis of any cause, by a single posterior approach after a period of HGT. Demographic data including age at surgery, sex, and body mass index were collected. Pre-traction, post-traction, postoperative major curve, and kyphosis angles were reported. Perioperative complications both during the traction period and postoperatively were recorded.

Results: 117 patients with a mean age at surgery of 14.0 ± 2.0 years were included. The mean preoperative major curve was 90.7°±22.1° (from 80.1 to 147.2°) and the mean kyphosis was 60.8°± 31.70 (from 3.3 to 150.2°). The mean major curve after traction was 66.1°±15.2° (from 30.2 to 101.5°) and 33.7°±17.0° (from 0.2° to 104.4°) postoperatively, with a total correction of 69 %. During the HGT period, 8 (6.8 %) complications occurred: 3 superficial infections, 4 pin displacement, and 1 case of encopresis. Postoperatively, eight deficits were observed, with two being permanent. No risk factors for postoperative neurological complications were identified.

Conclusions: A 6-week period of HGT is associated with a low complication rate, and is effective to prepare severe scoliosis surgery, even for curvatures exceeding 120°.