Halo-gravity traction (HGT) is a type of traction device utilized to treat spinal deformities such as scoliosis, congenital spine deformities, cervical instability, basilar invagination, and kyphosis. It is used prior to surgical treatment to reduce the difficulty of the following surgery and the need for a more dangerous surgery. The device works by applying weight to the spine in order to stretch and straighten it. Patients are capable of remaining somewhat active using a wheelchair or a walker while undergoing treatment. Most of the research suggests that HGT is a safe treatment, and it can even improve patients' nutrition or respiratory functioning. However, some patients may experience side effects such as headaches or neurological complications. The halo device itself was invented in the 1960s by doctors working at the Rancho Los Amigos hospital. Their work was published in a paper entitled "The Halo: A Spinal Skeletal Traction Fixation Device." The clinician Pierre Stagnara utilized the device to develop Halo-Gravity traction.
Technique Halo-gravity traction works by straightening and stretching the compressed spine. It relies on the viscoelastic properties of vertebrae. This means vertebrae can stretch over time. Doctors will apply weight to the spine, and gradually increase it over time, slowly straightening and stretching it. Patients undergoing the procedure will typically spend the entire course of the treatment, which is usually three to eight weeks, in a hospital. Usually, halo-gravity traction is the first step in the treatment plan for a child with severe spinal deformity. Following the procedure, it is common for a surgical operation such as spinal fusion surgery to be performed afterward to permanently mend the issue. It is utilized before the operation to reduce the need for a more dangerous surgery and to reduce the risk of damage to the soft tissues or nerves that surround the spine during the surgery. In addition, HGT has also been found to reduce the risk of complications during the following surgery. To perform halo-traction therapy a surgeon will use six to ten small pins to attach a "halo" made of a metal ring to the patient's skull. Doctors will typically leave one to two centimeters of distance between the halo and the patient's head. It is common for older patients to be given eight pins while younger patients are given 10. Prior to pin placement, some patients may undergo hair removal. It is not required for successful treatment, but it can help to reduce the risk of pin infection from hair getting caught in a pin or scalp necrosis. The pins will be placed into the forehead bones to prevent the head from moving. Pin placement is determined using a CT scan. The chosen area will be cleaned with betadine swabs. Usually, two to three pins are placed in the frontal and occipital areas. Pins placed on the occipital area will have to be placed one centimeter above and behind the auricle of the ear. Pins placed on the anterior of the head will likely be placed one centimeter above and to the sides of the eyebrow to avert potential damage to the supraorbital and the supratrochlear nerves, and potential muscle damage. Parietal placements are generally avoided as the skull around this area is generally softer, which risks the pins puncturing the temporal artery. Typically, the pins will tightened to a torque equivalent to the age of the child using a torque wrench. Adults can withstand tighter torques than children can. While this operation is being performed the child will be given general anesthesia. In infant children, significantly less torque is required to tighten the pins. This allows for the pins to be placed in more areas than they could be placed in older patients. Afterward, the halo will be attached to a pulley system which is attached to the patient's bed, walker, or wheelchair. Spring-type pulleys are typically used as they allow for the patient to self-regulate the weight applied to the pulley, which improves the safety of the device. Spring-based HGT devices are also cheaper and easier to build than other methods of construction. It is common for patients to begin the procedure with 5-10 pounds of weight on the pulley system. Over the next few weeks, clinicians will add weight to the pulley, which will slowly straighten the patient's spine over time. Eventually, a weight greater than 50% of the patient's body weight may be achieved. Doctors will monitor the movements and strength and will take x-rays of the patient to track their progress. They will adjust the amount of weight on the pulley system based on the results. All patients will undergo cranial nerve testing during the procedure. After the spine has reached its optimal position, spinal fusion surgery will be performed on the patient. While undergoing the procedure, patients are encouraged to remain as active as possible. Activities such as low-impact play, walking, or standing can all increase the benefits of halo-traction therapy. However, patients are limited to leaving the traction for only a short time span. They can leave for activities such as repositioning, changing clothes, daily medical care, showering, or using the toilet. Baby shampoo is required to be used for bathing purposes as other shampoos could contain chemicals that react negatively with the metal halo. Patients will be required to utilize a special bed for sleeping while in the traction. After ending treatment the patient is required to avoid strenuous activities for a few months as their spine and muscles will still need to recover. Some patients may wear an orthopedic vest or a halo vest.
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