Halo gravity traction for pediatric scoliosis and kyphoscoliosis: A review of current evidence and best practices

The surgical treatment of severe scoliosis and kyphoscoliosis in the pediatric population is complicated and has high morbidity and mortality risks. Severe scoliosis has traditionally been defined by a coronal Cobb angle of greater than 90° or 100°. The usual corrective methods for these patients have been anterior or posterior release and osteotomies using a combined anterior-posterior or posterior-only approach. Many of these patients have pre-existing pulmonary compromise; therefore, an anterior approach is often not reasonable or possible. Acute correction of a deformity may also cause neurologic injury. Halo gravity traction (HGT) allows for progressive, gradual, and sustained correction of the spinal deformity in the coronal, sagittal, and axial planes, leading to a decrease in the amount of correction needed at definitive posterior fusion. This relates to decreased postoperative neurologic deficit and improved pulmonary function. Preoperative HGT has evolved to be the surgical adjunct in the treatment of severe spinal deformity. Indications for HGT, best protocols of application, and optimal duration of traction still lack uniformity; thus, a review of the literature remains relevant and necessary. This review summarizes the existing literature on HGT, including its indications, applications, duration of traction, and associated complications.