Preoperative Halo Traction for Severe Scoliosis

Chang Ju Hwang, MD, PhD; Dong Gyun Kim, MD; Choon Sung Lee, MD, PhD; Dong-Ho Lee, MD, PhD; Jae Hwan Cho, MD, PhD; Jae-Woo Park, MD; Jong Min Baik, MD; Kwan Bum Lee, MD


Spine. 2020;45(18):E1158-E1165. 

In This Article

Abstract and Introduction


Study Design: Retrospective case control study.

Objective: The aim of this study was to analyze the appropriate traction period and preoperative halo traction (HT)-related factors in severe scoliosis

Summary of Background Data: HT can reduce risks involved in severe scoliosis treatment, and its safety and efficacy are well known. However, a lack of evidence exists in guiding the appropriate traction period and other factors involved in HT.

Methods: We retrospectively reviewed 59 patients who underwent preoperative HT, analyzed correction rate changes over time using HT, and assessed other factors by dividing the patients into two groups according to differences between the post-bending correction angle (PBC) and post-halo traction correction angle (PTC): group A (PBC ≒ PTC) and group B (PBC < PTC). The grouping was determined by whether the difference between PBC and PTC was >8°, the maximum measurement error when measuring the Cobb angle.

Results: The mean Cobb angle improved from 96.9° preoperatively to 72.9° post-bending to 63.3° post-traction and 32.5° postoperatively. The coronal correction of the major curve (change in curve from the start to each week/total change in curve after traction) was 28.2% at 1 week (n = 59), 34.0% at 2 weeks (n = 58), 33.8% at 3 weeks (n = 41), and 32.2% at 4 weeks (n = 13); a difference was noted between the first and second weeks (P < 0.001, <0.001, 0.244, and 0.082, respectively). Compared with group A, group B had a lower height (154.9 vs. 144.4 cm, P = 0.029), lower body weight (49.1 vs. 39.4 kg, P = 0.017), higher traction/body weight ratio (0.41 vs. 0.47, P = 0.025), and more halo-femoral traction (0 vs. 6, P = 0.018).

Conclusion: Traction for ≥3 weeks was unnecessary for optimal traction. In patients with low height and weight, halo-femoral traction with a heavy traction weight was effective.

Level of Evidence: 4


Surgical treatment of severe scoliosis, a relatively rare disease, is difficult, often resulting in several complications.[1] Operative procedures using anterior or posterior column release with osteotomies through the anterior–posterior approach or posterior-only approach are widely accepted. However, the acute correction of a severe curve may cause neurological damage. Additionally, many patients with scoliosis have poor pulmonary function, predisposing them to complications directly related to the operation itself or anesthesia.

Preoperative halo traction (HT) can be performed to reduce this risk.[2,3] Primary correction of spinal curvature through HT before surgery can provide an appropriate correction angle at the time of surgery and increase lung function and neurological stability.[4–6] However, despite HT being a promising procedure, there is a lack of evidence to guide the appropriate traction period and other factors involved in HT.

We evaluated the outcomes of HT performed for severe scoliosis at a single institution over 16 years. We aimed to determine the optimal traction period for preoperative HT and factors associated with optimal traction while using HT.