Neurosurgery notes/Procedures/TL spine procedures/Deformity techniques/Paediatric traction technique

Paediatric traction technique

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Deformity techniques
  • Indication
    • Severe scoliosis [Cobb angle > 70◦]
    • Rigid curves [flexibility index < 40%]
  • Halo-Gravity Traction (HGT)
    • See Closed reduction
    • Mechanism:
      • A halo ring is secured to the patient's skull and then progressively loaded with weights to apply longitudinal traction along the spine.
        • This gradual stretching facilitates soft tissue adaptation and vertebral realignment, improving the spine's flexibility before the definitive fusion surgery.
      • Unlike other forms of traction, HGT allows the patient to be mobilised in a wheelchair for the 2–8 weeks it is applied before surgery, reducing the risks associated with prolonged bed rest, such as pressure sores and respiratory infections.
    • Pros:
      • Safer and more widely used
        • Reduces neurological risk
          • That can occur with acute, forceful correction of a severe deformity.
      • Improves spinal flexibility
        • Which reduces the amount of force required during the final surgical correction.
      • Enhances pulmonary function
        • with studies showing improvements in forced vital capacity (FVC) and forced expiratory volume (FEV1), which is critical for patients with compromised lung function.
      • Achieves significant curve reduction before surgery.
        • Meta-analyses have confirmed HGT can achieve a mean reduction of approximately 27° in the coronal Cobb angle.
      • Improves nutritional status,
        • as better spinal alignment can facilitate improved gastrointestinal function.
    • Staged Procedures:
      • HGT can be part of a three-stage correction protocol where it is followed by an anterior release and then posterior instrumentation.
        • This approach has been shown to achieve better overall curve correction with shorter operative times compared to traditional two-stage approaches.
    • Risks:
      • Pin site infections
      • Cranial nerve palsies
      • Traction-related discomfort
        • Though these are generally manageable with careful monitoring.
  • Temporary Internal Distraction
      • This technique involves the use of internal distraction rods, similar to a unilateral growing rod construct, to apply controlled corrective forces across a spinal deformity.
      • Application:
        • For patients with cervical pathology that prevents the use of cranial traction.
        • The rods can span the entire curve for global alignment or target specific regions.
        • The procedure is often combined with osteotomies and soft tissue releases in either a single-stage or staged correction.
      • Specific Use:
        • Treating Lenke type 2 (double thoracic) curves.
          • A temporary rod is used to reduce the structural proximal thoracic curve by applying traction between its upper and lower end vertebrae.
          • This converts the sigmoid deformity into a single thoracic curve, which is more amenable to other corrective maneuvers like rod derotation.
          • A study by Sudo et al. demonstrated that this technique effectively corrected the curve and significantly increased thoracic kyphosis.
      • Risks:
        • This technique carries a significant risk of intraoperative neuromonitoring changes, with rates as high as 41%, although most are reversible.
        • Increased risk of anchor failure, and the anchors used for temporary distraction often cannot be reused as permanent fixation points.
      notion image
  • Others
    • Halo-femoral traction, Halo-tibial traction and Halo-pelvic traction associated with complications and require prolonged periods of bed confinement.