Halo-gravity traction combined with growing rod treatment: an effective preoperative management for severe early-onset scoliosis

<bold>Objective: </bold>The aim of this study was to investigate the effectiveness of preoperative halo-gravity traction (HGT) with subsequent growing rod (GR) treatment in patients with severe early-onset scoliosis (EOS).<bold>Methods: </bold>The authors retrospectively reviewed a cohort of patients with severe EOS who had received preoperative HGT with subsequent GR treatment at their center between January 2008 and January 2020. Patients with a Cobb angle in the coronal or sagittal plane that was > 90 degrees were included. All patients received at least 6 weeks of HGT before GR placement. Results of pulmonary function tests (PFTs) and blood gas tests were compared before and after HGT. Radiological parameters were compared pre-HGT, post-HGT, postindex surgery, and at the latest follow-up.<bold>Results: </bold>A total of 28 patients (17 boys and 11 girls, mean age 6.1 +/- 2.3 years) were included in this study. After a mean of 65.2 +/- 22.9 days of traction, the Cobb angle decreased from 101.4 degrees +/- 12.5 degrees to 74.5 degrees +/- 19.3 degrees (change rate 26.5%), and the kyphosis angle decreased from 71.1 degrees +/- 21.2 degrees to 42.7 degrees +/- 9.5 degrees (change rate 39.9%). There was a significant improvement in BMI but a decrease in hemoglobin levels following HGT. No HGT-related complications were recorded except pin site infections in 2 patients. Statistically significant improvements in PFTs after HGT were observed in forced vital capacity (FVC) (p = 0.011), the percentage predicted FVC (p = 0.007), FEV1 (p = 0.015), and the percentage predicted forced expiratory volume in 1 second (FEV1) (p = 0.005). Fourteen patients received assisted ventilation due to preoperative hypoxia, alveolar hypoventilation, or hypercapnia. Significant improvement was seen in PaCO2 (p = 0.008), PaO2 (p = 0.005), actual bicarbonate (p = 0.005), and oxygen saturation (p = 0.012) in these patients. After the index surgery, the Cobb angle decreased to 49.5 degrees +/- 18.9 degrees and the kyphosis angle decreased to 36.2 degrees +/- 25.8 degrees. After a mean of 4.3 +/- 1.4 lengthening procedures, the Cobb angle was 56.5 degrees +/- 15.8 degrees, and the kyphosis angle was 38.8 degrees +/- 19.7 degrees. Surgical complications occurred in 14 (50%) patients, but none of these patients required revision surgery at the latest follow-up.<bold>Conclusions: </bold>Preoperative HGT notably improved both spinal deformity and pulmonary function in patients with severe EOS. GR treatment after HGT is a safe and effective strategy for these patients.