Preoperative halo-gravity traction combined with one-stage posterior spinal fusion surgery following for severe rigid scoliosis with pulmonary dysfunction: a cohort study

Background To assess the efficacy of preoperative halo-gravity traction (HGT) in treating severe spinal deformities, evaluating radiological outcomes, pulmonary function, and nutritional status. Methods This study retrospectively included 33 patients with severe spinal deformity who were admitted to our department from April 2018 to January 2022. All the patients underwent HGT prior to the posterior spinal fusion corrective surgery, with no patients having undergone anterior or posterior release procedures. The correction of deformity, pulmonary function tests (PFTs), and nutritional status data were collected and analyzed before and after HGT. Results A total of 33 patients (9 males, 24 females) were finally included in this study with an average age of 17.79 +/- 7.96 (range 12-29) years. Among them, 20 patients were aged <= 16 years. The traction weight started from 1.5 kg and raised to 45.2 +/- 13.2% of body weight on average progressively, with the average traction duration of 129 +/- 63 days. After traction, the main curve was corrected from an average of 120.66 +/- 3.89 degrees to 94.88 +/- 3.35 degrees, and to 52.33 +/- 22.36 degrees (53%) after surgery(P < 0.05). PFTs also showed a significant increase in FVC%, FEV1%, and MEF% after traction [43.46 +/- 14.76% vs. 47.33 +/- 16.04%, 41.87 +/- 13.68% vs. 45.19 +/- 15.57%, and 40.44 +/- 15.87% vs. 45.24 +/- 17.91%, p < 0.05]. Total protein, albumin, and BMI were used as indicators of nutritional status. TP and albumin were significantly improved after traction, from 67.24 +/- 5.43 g/L to 70.68 +/- 6.98 g/L and 42.40 +/- 3.44 g/L 45.72 +/- 5.23 g/L, respectively(P < 0.05). No significant difference was found in deformity correction and lung function improvement between patients with traction for more or less than three months (p > 0.05). Two patients developed transient brachial plexus palsy during traction. Conclusions Halo-gravity traction can partially correct spinal deformity, enhance pulmonary function. And HGT has been shown to facilitate an improved nutritional status in these patients. It could be used as a preoperative adjuvant treatment for severe spinal deformity. However, according to the study, a traction period longer than three months may not be necessary.