Halo-Gravity Traction Versus Surgical Release Before Implantation of Expandable Spinal Devices A Comparison of Results and Complications in Early-Onset Spinal Deformity

Study Design: Between 1997 and 2009, 124 children with severe early-onset spinal deformity were treated with the vertical expandable prosthetic titanium rib or growing rods. Before the implantation of the device, 12 underwent halo-gravity traction (HGT) and 13 had a spinal release (SR). This observational study is based on x-rays obtained before and after surgery and at the last follow-up and on medical records. Objective: To describe the indications and effectiveness of HGT and SR in young patients treated with expandable devices. Summary of Background Data: Several studies have described the short-term effects of HGT and SR, in particular their safety and effectiveness on severe scoliosis, but none before the implantation of expandable spinal devices in severe early-onset spinal deformity. Methods: We measured the thoracic scoliosis and kyphosis, and the radiographic thoracic height and spinal length on x-rays. We also collected postoperative complications. Results: Postoperatively, SR resulted in a better correction of the scoliosis (46 degrees) than HGT or no release (37 and 27 degrees, respectively) but HGT provided a better correction of the kyphosis (48 degrees) than SR or no-spinal release (27 and 9 degrees, respectively). At follow-up, all groups showed a loss of correction of the kyphosis. The postoperative increase in thoracic spine height, which was initially greater in the HGT group because of the traction, became higher in the SR group at follow-up. Device complications occurred in 54% of the participants in the HGT group, 75% in the SR group, and 28% in the control group, and had a negative impact on the final thoracic spine height. Neurologic complications occurred in 8% of the participants and were more frequent in the HGT group (25%). Conclusions: The surgical procedures had different short-term impacts on the curve, which did not necessary predict long-term outcomes (loss of correction, loss of height increase). The risk of device loosening was high in the HGT and SR groups, as was the risk of neurologic loss.