halo-gravity traction device

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.{{Cite thesis |last=Dallasta |first=Samanta |type=PhD |publisher=Polytechnic of Milan |title=Design of a halo-gravity traction device for the management of spinal deformities in children |url=https://www.politesi.polimi.it/handle/10589/182984 |access-date=2023-11-05 |hdl=10589/182984}} 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.{{Cite web |title=Halo-Gravity Traction {{!}} Orthopedic Treatment for Spine Deformities {{!}} New Jersey |url=https://www.rwjbh.org/treatment-care/pediatrics/conditions-treatments/pediatric-orthopedic-care/halo-gravity-traction/ |url-status=live |archive-url=https://web.archive.org/web/20231023223218/https://www.rwjbh.org/treatment-care/pediatrics/conditions-treatments/pediatric-orthopedic-care/halo-gravity-traction/ |archive-date=October 23, 2023 |access-date=2023-10-23 |website=RWJBarnabas Health |language=en}}{{Cite journal |last1=Iyer |first1=Sravisht |last2=Duah |first2=Henry Ofori |last3=Wulff |first3=Irene |last4=Osei Tutu |first4=Henry |last5=Mahmud |first5=Rufai |last6=Yankey |first6=Kwadwo Poku |last7=Akoto |first7=Harry |last8=Boachie-Adjei |first8=Oheneba |author9=FOCOS Spine Research Group |date=2019-07-15 |title=The Use of Halo Gravity Traction in the Treatment of Severe Early Onset Spinal Deformity |url=https://journals.lww.com/spinejournal/abstract/2019/07150/the_use_of_halo_gravity_traction_in_the_treatment.11.aspx |journal=Spine |language=en-US |volume=44 |issue=14 |pages=E841–E845 |doi=10.1097/BRS.0000000000002997 |pmid=30817734 |s2cid=73481128 |issn=0362-2436|url-access=subscription }} 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.{{Cite journal |last1=Murphy |first1=Timothy P. |last2=Panarello |first2=Nicholas M. |last3=Baird |first3=Michael D. |last4=Helgeson |first4=Melvin D. |last5=Wagner |first5=Scott C. |date=2020-10-23 |title=Should Annular Closure Devices Be Utilized to Reduce the Risk of Recurrent Lumbar Disk Herniation? |url=http://dx.doi.org/10.1097/bsd.0000000000001104 |journal=Clinical Spine Surgery: A Spine Publication |volume=35 |issue=5 |pages=187–9 |doi=10.1097/bsd.0000000000001104 |pmid=33105160 |s2cid=225082569 |issn=2380-0186|url-access=subscription }}{{Cite journal |last1=Mehrpour |first1=Saeedreza |last2=Sorbi |first2=Reza |last3=Rezaei |first3=Reza |last4=Mazda |first4=Keyvan |date=2017-04-01 |title=Posterior-only surgery with preoperative skeletal traction for management of severe scoliosis |url=https://doi.org/10.1007/s00402-017-2642-x |journal=Archives of Orthopaedic and Trauma Surgery |language=en |volume=137 |issue=4 |pages=457–463 |doi=10.1007/s00402-017-2642-x |pmid=28185083 |s2cid=6900242 |issn=1434-3916|url-access=subscription }} In addition, HGT has also been found to reduce the risk of complications during the following surgery.{{Cite journal |last1=Iyer |first1=Sravisht |last2=Boachie-Adjei |first2=Oheneba |last3=Duah |first3=Henry Ofori |last4=Yankey |first4=Kwadwo Poku |last5=Mahmud |first5=Rufai |last6=Wulff |first6=Irene |last7=Tutu |first7=Henry Osei |last8=Akoto |first8=Harry |author9=FOCOS Spine Research Group |date=2019-05-01 |title=Halo Gravity Traction Can Mitigate Preoperative Risk Factors and Early Surgical Complications in Complex Spine Deformity |url=https://journals.lww.com/spinejournal/abstract/2019/05010/halo_gravity_traction_can_mitigate_preoperative.10.aspx |journal=Spine |language=en-US |volume=44 |issue=9 |pages=629–636 |doi=10.1097/BRS.0000000000002906 |pmid=30325883 |s2cid=53527401 |issn=0362-2436|url-access=subscription }}{{Cite journal |last1=Nemani |first1=Venu M. |last2=Kim |first2=Han Jo |last3=Bjerke-Kroll |first3=Benjamin T. |last4=Yagi |first4=Mitsuru |last5=Sacramento-Dominguez |first5=Cristina |last6=Akoto |first6=Harry |last7=Papadopoulos |first7=Elias C. |last8=Sanchez-Perez-Grueso |first8=Francisco |last9=Pellise |first9=Ferran |last10=Nguyen |first10=Joseph T. |last11=Wulff |first11=Irene |last12=Ayamga |first12=Jennifer |last13=Mahmud |first13=Rufai |last14=Hodes |first14=Richard M. |last15=Boachie-Adjei |first15=Oheneba |date=2015-02-01 |title=Preoperative Halo-Gravity Traction for Severe Spinal Deformities at an SRS-GOP Site in West Africa: Protocols, Complications, and Results |url=https://journals.lww.com/spinejournal/abstract/2015/02010/preoperative_halo_gravity_traction_for_severe.9.aspx |journal=Spine |language=en-US |volume=40 |issue=3 |pages=153–161 |doi=10.1097/BRS.0000000000000675 |pmid=25668334 |s2cid=20091375 |issn=0362-2436|url-access=subscription }}{{Cite journal |last1=Li |first1=Yang |last2=Shi |first2=Benlong |last3=Zhu |first3=Zezhang |last4=Liu |first4=Zhen |last5=Liu |first5=Dun |last6=Shi |first6=Bo |last7=Sun |first7=Xu |last8=Qiu |first8=Yong |date=2021-03-01 |title=Preoperative Halo-Gravity Traction for Patients with Severe Focal Kyphosis in the Upper Thoracic Spine: A Safe and Effective Alternative for Three-Column Osteotomy |url=https://journals.lww.com/spinejournal/abstract/2021/03010/preoperative_halo_gravity_traction_for_patients.10.aspx?context=featuredarticles&collectionid=2 |journal=Spine |language=en-US |volume=46 |issue=5 |pages=307–312 |doi=10.1097/BRS.0000000000003782 |pmid=33156274 |s2cid=226272150 |issn=0362-2436|url-access=subscription }}

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.{{Cite book |last=Herring |first=John A. |url=https://books.google.com/books?id=3p4REAAAQBAJ |title=Tachdjian's Pediatric Orthopaedics: From the Texas Scottish Rite Hospital for Children: 2-Volume Set |date=2020-11-27 |publisher=Elsevier Health Sciences |isbn=978-0-323-56695-7 |pages=201 |language=en}}{{Cite book |last1=Wang |first1=Yan |url=https://books.google.com/books?id=2_abBQAAQBAJ |title=Spinal Osteotomy |last2=Boachie-Adjei |first2=Oheneba |last3=Lenke |first3=Lawrence |date=2014-11-26 |publisher=Springer |isbn=978-94-017-8038-4 |pages=213 |language=en}}{{Cite journal |last1=Kimsal |first1=Julie |last2=Khraishi |first2=Tariq |last3=Izadi |first3=Kayvon |last4=Limanovich |first4=Eugene |date=2009 |title=Experimental investigation of halo-gravity traction for paediatric spinal deformity correction |url=http://www.inderscience.com/link.php?id=29197 |journal=International Journal of Experimental and Computational Biomechanics |language=en |volume=1 |issue=2 |pages=204 |doi=10.1504/IJECB.2009.029197 |issn=1755-8735|url-access=subscription }} 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 to above 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.{{Cite journal |last1=Semmelink |first1=K. |last2=Hekman |first2=E. E. G. |last3=van Griethuysen |first3=M. |last4=Bosma |first4=J. |last5=Swaan |first5=A. |last6=Kruyt |first6=M. C. |date=2021-01-01 |title=Halo pin positioning in the temporal bone; parameters for safe halo gravity traction |url=https://doi.org/10.1007/s43390-020-00194-2 |journal=Spine Deformity |language=en |volume=9 |issue=1 |pages=255–261 |doi=10.1007/s43390-020-00194-2 |pmid=32915397 |s2cid=221619311 |issn=2212-1358}} Whilst 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.{{Cite journal |last1=Mubarak |first1=S. J. |last2=Camp |first2=J. F. |last3=Vuletich |first3=W. |last4=Wenger |first4=D. R. |last5=Garfin |first5=S. R. |date=1989 |title=Halo application in the infant |journal=Journal of Pediatric Orthopedics |volume=9 |issue=5 |pages=612–4 |doi=10.1097/01241398-198909010-00021 |issn=0271-6798 |pmid=2794039}}

Afterward, the halo will be attached to a pulley system which is attached to the patient's bed, walker, or wheelchair.{{Cite journal |last1=Mullan |first1=Betsy |last2=Turner-Bare |first2=Karen R. |last3=Pedicone |first3=Dave |last4=Shannon |first4=Christina |last5=Kane |first5=Meghan |last6=Hancock |first6=Sarah |last7=Rahman |first7=Tariq |last8=Ditro |first8=Colleen |last9=Mackenzie |first9=William |last10=Gabos |first10=Peter |last11=Shah |first11=Suken A. |date=2018 |title=A Method of Facilitating Mobility in Children Undergoing Halo Skeletal Traction |url=https://journals.lww.com/jcejournal/abstract/2018/07000/a_method_of_facilitating_mobility_in_children.13.aspx |journal=Journal of Clinical Engineering |language=en-US |volume=43 |issue=3 |pages=122 |doi=10.1097/JCE.0000000000000285 |s2cid=126011734 |issn=0363-8855|url-access=subscription }} 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.{{Cite book |last1=Akbarnia |first1=Behrooz A. |url=https://books.google.com/books?id=y7u6Esp7a1EC |title=The Growing Spine: Management of Spinal Disorders in Young Children |last2=Yazici |first2=Muharrem |last3=Thompson |first3=George H. |date=2010-12-31 |publisher=Springer |isbn=978-3-540-85207-0 |pages=384–9 }}{{Rp|page=390}} Spring-based HGT devices are also cheaper and easier to build than other methods of construction.{{Cite journal |last1=Yu |first1=Henry |last2=Kim |first2=Eun |last3=Garg |first3=Sumeet |date=2020 |title=Development of a spring-based weight system for halo gravity traction for complex pediatric spinal deformity |journal=Spine Deformity |volume=8 |issue=5 |pages=879–884 |doi=10.1007/s43390-020-00117-1 |issn=2212-1358 |pmid=32303999|s2cid=215809652 }} It is common for patients to begin the procedure with 5-10 pounds of weight on the pulley system.{{Rp|page=387}} 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.{{Cite book |last=Yazici |first=Muharrem |url=https://books.google.com/books?id=Mrj5OTkEk4YC |title=Non-Idiopathic Spine Deformities in Young Children |date=2011-07-21 |publisher=Springer |isbn=978-3-642-19417-7 |pages=116–9 }} 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.{{Cite web |title=Halo-Gravity Traction {{!}} Boston Children's Hospital |url=https://www.childrenshospital.org/treatments/halo-gravity-traction |url-status=live |archive-url=https://web.archive.org/web/20230401003732/https://www.childrenshospital.org/treatments/halo-gravity-traction |archive-date=April 1, 2023 |access-date=2023-10-23 |website=www.childrenshospital.org}}

Whilst 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 whilst 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.

Halo-gravity traction has been found to be almost completely safe.{{Rp|page=385}}{{Cite journal |last1=Wang |first1=Jianqiang |last2=Han |first2=Bo |last3=Hai |first3=Yong |last4=Su |first4=Qingjun |last5=Chen |first5=Yuxiang |date=2021-11-01 |title=How helpful is the halo-gravity traction in severe spinal deformity patients?: A systematic review and meta-analysis |url=https://doi.org/10.1007/s00586-021-06902-4 |journal=European Spine Journal |language=en |volume=30 |issue=11 |pages=3162–71 |doi=10.1007/s00586-021-06902-4 |pmid=34185131 |s2cid=235664288 |issn=1432-0932|url-access=subscription }} Patients who have undergone the procedure report that they have a greater ability to stand upright, an increased appetite, and an improved body image.{{Cite journal |last=Paksoy |first=Kemal |date=2023-05-13 |title=The Effect of Halo Gravity Traction Application on Trunk Visual Perception in Severe and Rigid Kyphoscoliosis Patients |url=https://ejournal.lucp.net/index.php/mjmr/article/view/2054 |journal=Malaysian Journal of Medical Research |language=en |volume=7 |issue=2 |pages=14–21 |doi=10.31674/mjmr.2023.v07i02.002 |s2cid=259545832 |issn=2550-1607|doi-access=free }} It can improve respiratory functioning by relieving pressure on the lungs caused by a deformed spine.{{Citation |last1=Ramo |first1=Brandon A. |title=Halo-Gravity Traction |date=2022 |url=https://doi.org/10.1007/978-3-030-84393-9_30 |work=The Growing Spine: Management of Spinal Disorders in Young Children |pages=543–7 |editor-last=Akbarnia |editor-first=Behrooz A. |access-date=2023-10-27 |publisher=Springer |doi=10.1007/978-3-030-84393-9_30 |isbn=978-3-030-84393-9 |last2=Johnston |first2=Charles E. |editor2-last=Thompson |editor2-first=George H. |editor3-last=Yazici |editor3-first=Muharrem |editor4-last=El-Hawary |editor4-first=Ron|url-access=subscription }}{{Cite journal |last1=Nepple |first1=Jeffrey J. |last2=Lenke |first2=Lawrence G. |date=2009 |title=Severe idiopathic scoliosis with respiratory insufficiency treated with preoperative traction and staged anteroposterior spinal fusion with a 2-level apical vertebrectomy |journal=The Spine Journal|volume=9 |issue=7 |pages=e9–e13 |doi=10.1016/j.spinee.2009.01.009 |issn=1878-1632 |pmid=19233737}}{{Cite journal |last1=LaMont |first1=Lauren E. |last2=Jo |first2=ChanHee |last3=Molinari |first3=Sarah |last4=Tran |first4=Dong |last5=Caine |first5=Heather |last6=Brown |first6=Kaitlyn |last7=Wittenbrook |first7=Wendy |last8=Schochet |first8=Peter |last9=Johnston |first9=Charles E. |last10=Ramo |first10=Brandon |date=2019 |title=Radiographic, Pulmonary, and Clinical Outcomes With Halo Gravity Traction |journal=Spine Deformity |volume=7 |issue=1 |pages=40–46 |doi=10.1016/j.jspd.2018.06.013 |issn=2212-1358 |pmid=30587319|s2cid=58659369 }} Patients often gain weight and have improved nutrition following HGT.{{Citation |last=McClung |first=Anna |title=Preoperative and Postoperative Care Including Use of Halo-Gravity Traction |date=2015 |url=https://doi.org/10.1007/978-94-017-8038-4_17 |work=Spinal Osteotomy |pages=239–244 |editor-last=Wang |editor-first=Yan |access-date=2023-11-15 |place=Dordrecht |publisher=Springer |doi=10.1007/978-94-017-8038-4_17 |isbn=978-94-017-8038-4 |editor2-last=Boachie-Adjei |editor2-first=Oheneba |editor3-last=Lenke |editor3-first=Lawrence|url-access=subscription }} This may occur since HGT can correct issues associated with spinal deformities, such as exercise, comorbid metabolic disorders, and gastrointestinal malformations. These issues are associated with malnutrition and low weight, and HGT can lead to weight gain by correcting them.{{Cite journal |last1=Reed |first1=Logan A. |last2=Mihas |first2=Alexander |last3=Butler |first3=Reed |last4=Pratheep |first4=Guna |last5=Manoharan |first5=Sakthivel Rajaram |last6=Theiss |first6=Steven |last7=Viswanathan |first7=Vibhu Krishnan |date=2022-08-01 |title=Halo Gravity Traction for the Correction of Spinal Deformities in the Pediatric Population: A Systematic Review and Meta-Analysis |url=https://www.sciencedirect.com/science/article/pii/S1878875022006271 |journal=World Neurosurgery |volume=164 |pages=e636–e648 |doi=10.1016/j.wneu.2022.05.026 |pmid=35577210 |s2cid=248794517 |issn=1878-8750|url-access=subscription }} When in combination with surgical release, HGT may improve the flexibility of the spine and lead to more spinal correction.{{Cite journal |last1=Koller |first1=Heiko |last2=Zenner |first2=Juliane |last3=Gajic |first3=Vera |last4=Meier |first4=Oliver |last5=Ferraris |first5=Luis |last6=Hitzl |first6=Wolfgang |date=2012 |title=The impact of halo-gravity traction on curve rigidity and pulmonary function in the treatment of severe and rigid scoliosis and kyphoscoliosis: a clinical study and narrative review of the literature |url=https://doi.org/10.1007/s00586-011-2046-5 |journal=European Spine Journal |language=en |volume=21 |issue=3 |pages=514–529 |doi=10.1007/s00586-011-2046-5 |pmc=3296862 |pmid=22042044}}

Patients may experience pain from the pins, which is usually caused by the loosening of the pins. This can be remedied by tightening them. Up to 20% of patients may experience infections at the site where the pins were applied. These infections are typically treated with antibiotics. One rare, but serious complication of the procedure can be the development of intra-cranial abscesses due to septic contamination of the pin site. Some patients experience headaches around the area where the pins were applied for a short while after the halo is attached. It is common for patients to recover from this pain in less than 24 hours.{{Rp|page=384}} Halo therapy will leave small lesions in the skin when the pins are first removed. Typically, they will turn into scabs after a few days. Patients who have undergone the procedure will also have small scars on their foreheads. These scars will typically fade over time.

If the traction that is applied is greater than the tolerable amount, the patient may feel cervical pain, cranial nerve lesions, nausea, vertigo, or dizziness. These side effects are treated by lowering the level of weight applied.{{Cite journal |last1=Pratheep |first1=Guna K. |last2=Viswanathan |first2=Vibhu K. |last3=Manoharan |first3=Sakthivel R. R. |date=2023 |title=Pre-operative Halo-gravity Traction in the Treatment of Complex Spinal Deformities: What Do We Know So Far?: A Systematic Review |url=https://journals.lww.com/isoj/Fulltext/2023/06010/Pre_operative_Halo_gravity_Traction_in_the.8.aspx |journal=Indian Spine Journal |language=en-US |volume=6 |issue=1 |pages=65 |doi=10.4103/isj.isj_26_22 |issn=2589-5079 |doi-access=free }} Some patients may suffer from motor paresis after the application of the device. Typically it is present in patients with preexisting spinal cord abnormalities.{{Rp|page=389}} Generally, HGT does not cause neurological side effects due to the slow progression of traction. The spine adjusts slowly over time, and as a result, consequences are generally limited. Children are less likely than adolescents or adults to experience neurological side effects, due to the softness and flexibility of their spine, as well as their low weight.{{cite journal | doi=10.1007/s11832-016-0721-0 | title=Preoperative halo-gravity traction with and without thoracoscopic anterior release for skeletal dysplasia patients with severe kyphoscoliosis | date=2016 | last1=Pourtaheri | first1=Sina | last2=Shah | first2=Suken A. | last3=Ditro | first3=Colleen P. | last4=Holmes | first4=Laurens | last5=MacKenzie | first5=William G. | journal=Journal of Children's Orthopaedics | volume=10 | issue=2 | pages=135–142 | pmid=27016925 | pmc=4837168 }}

Erb's palsy has been identified as a rare neurological side effect of HGT.{{Cite journal |last1=El-Shaker |first1=Mohammed |last2=Watts |first2=Hugh G. |date=1991 |title=Acute Brachial Plexus Neuropathy Secondary to Halo-Gravity Traction in a Patient with Ehlers-Danlos Syndrome |url=https://journals.lww.com/spinejournal/citation/1991/03000/acute_brachial_plexus_neuropathy_secondary_to.29.aspx |journal=Spine |language=en-US |volume=16 |issue=3 |pages=385–6 |doi=10.1097/00007632-199103000-00029 |pmid=1851333 |issn=0362-2436|url-access=subscription }} One 2006 study published in the journal "Studies in Health Technology and Informatics" found that in extremely rare cases HGT could induce Erb's palsy, ulnar nerve paralysis, and median nerve palsy in cases. In the seven cases identified by the study, all patients had fully recovered within a few months of treatment. The likelihood of developing Erb's palsy due to HGT is associated with the weight of the traction.{{Citation |last1=Qian |first1=Bang-Ping |title=Brachial Plexus Palsy Associated with Halo Traction before Posterior Correction in Severe Scoliosis |date=2006 |url=https://ebooks.iospress.nl/publication/9619 |work=Research into Spinal Deformities 5 |pages=538–542 |access-date=2023-11-03 |publisher=IOS Press |last2=Qiu |first2=Yong |last3=Wang |first3=Bin}} Another study published in the Journal of Spinal Disorders & Techniques found that patients may experience Erb's palsy or sensory loss during or after treatment. However, none of the patients who had experienced these side effects reported in this study had permanent neurological loss.{{Cite journal |last1=Caubet |first1=Jean-François |last2=Emans |first2=John B. |date=2011 |title=Halo-Gravity Traction Versus Surgical Release Before Implantation of Expandable Spinal Devices: A Comparison of Results and Complications in Early-Onset Spinal Deformity |url=https://journals.lww.com/jspinaldisorders/abstract/2011/04000/halo_gravity_traction_versus_surgical_release.5.aspx |journal=Clinical Spine Surgery |language=en-US |volume=24 |issue=2 |pages=99–104 |doi=10.1097/BSD.0b013e3181d96e7d |pmid=21445022 |s2cid=22466948 |issn=2380-0186|url-access=subscription }}

One 2016 clinical study published in BioMed Research International found that HGT resulted in reduced bone density among patients with kyphoscoliosis.{{Cite journal |last1=Han |first1=Xiao |last2=Sun |first2=Weixiang |last3=Qiu |first3=Yong |last4=Xu |first4=Leilei |last5=Sha |first5=Shifu |last6=Shi |first6=Benlong |last7=Yan |first7=Huang |last8=Liu |first8=Zhen |last9=Zhu |first9=Zezhang |date=2016-11-08 |title=Halo Gravity Traction Is Associated with Reduced Bone Mineral Density of Patients with Severe Kyphoscoliosis |journal=BioMed Research International |language=en |volume=2016 |pages=e8056273 |doi=10.1155/2016/8056273 |issn=2314-6133 |pmc=5118551 |pmid=27896274 |doi-access=free}} However, little other research has investigated this potential side effect or found any evidence to support this claim.

Patients with bone conditions such as fibrous dysplasia or osteogenesis imperfecta may be unsuitable for treatment if the pins are not capable of safely being applied to the bone.{{Rp|page=385}} Osteoporosis is considered a contraindication that sometimes may prevent treatment, however, doctors may avert complications by utilizing more pins with a lower torque.{{Cite journal |last1=Braun |first1=Sebastian |last2=Brenneis |first2=Marco |last3=Schönnagel |first3=Lukas |last4=Caffard |first4=Thomas |last5=Diaremes |first5=Panagiotis |date=2023 |title=Surgical Treatment of Spinal Deformities in Pediatric Orthopedic Patients |journal=Life |language=en |volume=13 |issue=6 |pages=1341 |doi=10.3390/life13061341 |pmid=37374124 |pmc=10302009 |bibcode=2023Life...13.1341B |issn=2075-1729 |doi-access=free }} Absolute contraindications for halo-gravity traction include the presence of a stenotic segment, an intradural or extradural lesion, lesions in the skull by the sites of pin application, any lesion or tumor by the spine cord, severe skull deformity, and spine instability.

Most of the research conducted on HGT found that it is mostly a safe,{{Cite journal |last1=Garabekyan |first1=Tigran |last2=Hosseinzadeh |first2=Pooya |last3=Iwinski |first3=Henry J. |last4=Muchow |first4=Ryan D. |last5=Talwalkar |first5=Vishwas R. |last6=Walker |first6=Janet |last7=Milbrandt |first7=Todd A. |date=2014 |title=The results of preoperative halo-gravity traction in children with severe spinal deformity |url=https://journals.lww.com/jpo-b/abstract/2014/01000/the_results_of_preoperative_halo_gravity_traction.1.aspx |journal=Journal of Pediatric Orthopaedics B |language=en-US |volume=23 |issue=1 |pages=1–5 |doi=10.1097/BPB.0b013e32836486b6 |pmid=23942045 |s2cid=30015658 |issn=1060-152X|url-access=subscription }} reliable, and effective treatment.{{Cite journal |last1=Sink |first1=Ernest L. |last2=Karol |first2=Lori A. |last3=Sanders |first3=James |last4=Birch |first4=John G. |last5=Johnston |first5=Charles E. |last6=Herring |first6=J. Anthony |date=2001 |title=Efficacy of Perioperative Halo-Gravity Traction in the Treatment of Severe Scoliosis in Children |url=https://journals.lww.com/pedorthopaedics/abstract/2001/07000/efficacy_of_perioperative_halo_gravity_traction_in.20.aspx |journal=Journal of Pediatric Orthopaedics |language=en-US |volume=21 |issue=4 |pages=519–524 |doi=10.1097/01241398-200107000-00020 |pmid=11433168 |issn=0271-6798|url-access=subscription }}{{Cite journal |last1=Rinella |first1=Anthony |last2=Lenke |first2=Lawrence |last3=Whitaker |first3=Camden |last4=Kim |first4=Yongjung |last5=Park |first5=Soo-sung |last6=Peelle |first6=Michael |last7=Edwards |first7=Charles |last8=Bridwell |first8=Keith |date=2005-02-15 |title=Perioperative Halo-Gravity Traction in the Treatment of Severe Scoliosis and Kyphosis |url=https://journals.lww.com/spinejournal/abstract/2005/02150/perioperative_halo_gravity_traction_in_the.17.aspx |journal=Spine |language=en-US |volume=30 |issue=4 |pages=475–482 |doi=10.1097/01.brs.0000153707.80497.a2 |pmid=15706347 |s2cid=25945252 |issn=0362-2436|url-access=subscription }} The average correction rate of HGT has been shown to be 19.4% for sagittal curves and 24.1% coronal curvature. One 2013 study on 33 patients published in the journal Spine Deformity found an average correction rate of 33% for coronal curves and 35% for sagittal.{{cite journal |vauthors=Bogunovic L, Lenke LG, Bridwell KH, Luhmann SJ |title=Preoperative Halo-Gravity Traction for Severe Pediatric Spinal Deformity: Complications, Radiographic Correction and Changes in Pulmonary Function |journal=Spine Deform |volume=1 |issue=1 |pages=33–39 |date=January 2013 |pmid=27927320 |doi=10.1016/j.jspd.2012.09.003 }} According to a cohort study conducted on 75 subjects investigating the efficacy of Halo traction therapy found an improvement rate of 31% to 66% for the spine. They found a coronal curvature improvement of 19.6% for adolescents, and 12% for adults. Kyphosis had improved at a rate of 23.9% for adolescents. Afterward, spinal surgery performed on people who had undergone the procedure had a greater than 50% chance of success.{{Cite journal |last1=Liu |first1=Delong |last2=Yang |first2=Jingfan |last3=Sui |first3=Wenyuan |last4=Deng |first4=Yaolong |last5=Li |first5=Fenghua |last6=Yang |first6=Junlin |last7=Huang |first7=Zifang |date=2022-10-01 |title=Efficacy of Halo-Gravity Traction in the Perioperative Treatment of Severe Scoliosis and Kyphosis: A Comparison of Adolescent and Adult Patients |url=https://www.sciencedirect.com/science/article/pii/S1878875022008725 |journal=World Neurosurgery |volume=166 |pages=e70–6 |doi=10.1016/j.wneu.2022.06.087 |pmid=35809839 |s2cid=250383664 |issn=1878-8750|url-access=subscription }}

One study conducted on 20 patients with either scoliosis, kyphosis, or kyphoscoliosis found that the most improvement occurred within the first 3 weeks of treatment. According to this study, the spinal curve had improved by 63.7% during the first two weeks, which decreased to 24.3% at 3 weeks, and to 15.9% at 4 weeks.{{Cite journal |last1=Park |first1=Daniel K. |last2=Braaksma |first2=Brian |last3=Hammerberg |first3=Kim W. |last4=Sturm |first4=Peter |date=2013 |title=The Efficacy of Preoperative Halo-Gravity Traction in Pediatric Spinal Deformity: The Effect of Traction Duration |url=https://journals.lww.com/jspinaldisorders/abstract/2013/05000/the_efficacy_of_preoperative_halo_gravity_traction.5.aspx |journal=Clinical Spine Surgery |language=en-US |volume=26 |issue=3 |pages=146–154 |doi=10.1097/BSD.0b013e318237828c |pmid=23750343 |s2cid=9013634 |issn=2380-0186|url-access=subscription }} Other studies have found similar results. One study conducted on 21 patients found that 45% of improvement occurred within the first 3 weeks.{{Cite journal |last1=Tokunaga |first1=Makoto |last2=Minami |first2=Shohei |last3=Kitahara |first3=Hiroshi |last4=Isobe |first4=Keijiro |last5=Nakata |first5=Yoshinori |last6=Moriya |first6=Hideshige |date=2000-02-15 |title=Vertebral Decancellation for Severe Scoliosis |url=https://journals.lww.com/spinejournal/abstract/2000/02150/vertebral_decancellation_for_severe_scoliosis.13.aspx |journal=Spine |language=en-US |volume=25 |issue=4 |pages=469–474 |doi=10.1097/00007632-200002150-00013 |pmid=10707393 |issn=0362-2436|url-access=subscription }} Another study on 24 patients found that a mean improvement of 82% occurred during the first three weeks.{{Cite journal |last1=Rocos |first1=Brett |last2=Reda |first2=Luke |last3=Lebel |first3=David E. |last4=Dodds |first4=Michael K. |last5=Zeller |first5=Reinhard |date=2021 |title=The Use of Halo Gravity Traction in Severe, Stiff Scoliosis |url=https://journals.lww.com/pedorthopaedics/abstract/2021/07000/the_use_of_halo_gravity_traction_in_severe,_stiff.6.aspx |journal=Journal of Pediatric Orthopaedics |language=en-US |volume=41 |issue=6 |pages=338–343 |doi=10.1097/BPO.0000000000001830 |pmid=33826561 |s2cid=233183231 |issn=0271-6798|url-access=subscription }}

Much of the research utilized as evidence of the efficacy of HGT has been criticized for a lack of a control group and a small sample size.{{Cite journal |last1=Sponseller |first1=Paul D. |last2=Takenaga |first2=Ryan K. |last3=Newton |first3=Peter |last4=Boachie |first4=Oheneba |last5=Flynn |first5=Jack |last6=Letko |first6=Lynn |last7=Betz |first7=Randal |last8=Bridwell |first8=Keith |last9=Gupta |first9=Munish |last10=Marks |first10=Michelle |last11=Bastrom |first11=Tracey |date=2008-10-01 |title=The Use of Traction in the Treatment of Severe Spinal Deformity |url=https://journals.lww.com/spinejournal/fulltext/2008/10010/the_use_of_traction_in_the_treatment_of_severe.10.aspx |journal=Spine |language=en-US |volume=33 |issue=21 |pages=2305–9 |doi=10.1097/BRS.0b013e318184ef79 |pmid=18827696 |s2cid=205510406 |issn=0362-2436|doi-access=free |url-access=subscription }} Some research has suggested that HGT leads to statistically insignificant improvement.{{Cite journal |last1=Flierl |first1=S. |last2=Carstens |first2=C. |date=1997 |title=Der Effekt der Halo-Schwerkraft-Traktion bei der präoperativen Behandlung der neuromuskulären Skoliose |url=http://www.thieme-connect.de/DOI/DOI?10.1055/s-2008-1039574 |journal=Zeitschrift für Orthopädie und ihre Grenzgebiete |language=de |volume=135 |issue=2 |pages=162–170 |doi=10.1055/s-2008-1039574 |pmid=9214176 |s2cid=260354631 |issn=0044-3220|url-access=subscription }} Paul Sponseller, an Orthopedic surgeon at Johns Hopkins University, claims in his study "The use of traction in the treatment of severe spinal deformity" that his research found "no statistically significant difference in main coronal curve correction (62% vs. 59%), operative time, blood loss, and total complication rate (27% vs. 52%)." However, his data did showcase that people who had not undergone HGT required surgical resection 30% more often. In a study on 25 patients with severe spinal deformities who had been treated with spinal surgery, a mean correction of 44 degrees was found in patients who had not undergone HGT prior to the operation, and a mean correction of 52 was found in patients who had been treated with HGT. The researchers concluded that this difference was not statistically significant, and therefore HGT should not be used as the general treatment for these issues, and should be reserved for specific cases.{{Cite journal |last1=Seller |first1=K. |last2=Haas |first2=S. |last3=Raab |first3=P. |last4=Krauspe |first4=R. |last5=Wild |first5=A. |date=2005 |title=Die präoperative Halo-Extension bei hochgradiger Lähmungsskoliose |url=http://www.thieme-connect.de/DOI/DOI?10.1055/s-2005-836750 |journal=Zeitschrift für Orthopädie und ihre Grenzgebiete |language=de |volume=143 |issue=5 |pages=539–543 |doi=10.1055/s-2005-836750 |pmid=16224673 |s2cid=260354087 |issn=0044-3220|url-access=subscription }}

Some research suggests that HGT may be less effective than other forms of traction, such as Halo-femoral traction or Halo-pelvic traction.{{Cite journal |last1=Sun |first1=Yan |last2=Zhang |first2=Yong |last3=Ma |first3=Haoning |last4=Tan |first4=Mingsheng |last5=Zhang |first5=Zhihai |date=2023-03-01 |title=Halo-pelvic traction in the treatment of severe scoliosis: a meta-analysis |journal=European Spine Journal |language=en |volume=32 |issue=3 |pages=874–882 |doi=10.1007/s00586-023-07525-7 |pmid=36622456 |s2cid=255545260 |issn=1432-0932|doi-access=free }}{{cite journal |vauthors=Shi B, Liu D, Shi B, Li Y, Xia S, Jiang E, Qiu Y, Zhu Z |title=A Retrospective Study to Compare the Efficacy of Preoperative Halo-Gravity Traction and Postoperative Halo-Femoral Traction After Posterior Spinal Release in Corrective Surgery for Severe Kyphoscoliosis |journal=Med Sci Monit |volume=26 |issue= |pages=e919281 |date=February 2020 |pmid=32015301 |pmc=7020739 |doi=10.12659/MSM.919281 }} HGT also has been found to require lengthy hospital stays, which many patients dislike about the treatment.{{Cite journal |last1=Buchowski |first1=Jacob M. |last2=Skaggs |first2=David L. |last3=Sponseller |first3=Paul D. |date=2007 |title=Temporary Internal Distraction as an Aid to Correction of Severe Scoliosis: Surgical Technique |url=https://journals.lww.com/jbjsjournal/abstract/2007/09001/temporary_internal_distraction_as_an_aid_to.12.aspx |journal=JBJS |language=en-US |volume=89 |issue=2 |pages=297–309 |doi=10.2106/JBJS.G.00163 |pmid=17768223 |issn=0021-9355|url-access=subscription }} In the study by Paul Sponsellor, he found that patients who had undergone HGT spent almost twice the amount of time hospitalized as those who had not received the treatment. HGT is significantly safer than other forms of traction. It is less likely to produce significant complications such as blood loss,{{cite journal |vauthors=Rohozynskyi VA, Levytskyi AF, Dolianytskyi MM, Benzar IM |title=Treatment of Severe Spinal Deformations in Children with Idiopathic Scoliosis using Halo-Gravity Traction |journal=Wiad Lek |volume=73 |issue=10 |pages=2144–9 |date=2020 |doi=10.36740/WLek202010107 |pmid=33310937 |url=https://wiadlek.pl/wp-content/uploads/archive/2020/WLek202010107.pdf}} neurological side effects, and spine stiffness or degeneration.{{Cite journal |last1=Chen |first1=Jian |last2=Sui |first2=Wen-yuan |last3=Yang |first3=Jing-fan |last4=Deng |first4=Yao-long |last5=Xu |first5=Jing |last6=Huang |first6=Zi-fang |last7=Yang |first7=Jun-lin |date=2021-01-23 |title=The radiographic, pulmonary, and clinical outcomes of patients with severe rigid spinal deformities treated via halo-pelvic traction |journal=BMC Musculoskeletal Disorders |volume=22 |issue=1 |pages=106 |doi=10.1186/s12891-021-03953-y |issn=1471-2474 |pmc=7825157 |pmid=33485304 |doi-access=free }} HGT also allows patients to remain social and active, whilst other forms of traction severely restrict movement.{{Cite journal |last1=Koptan |first1=Wael |last2=ElMiligui |first2=Yasser |date=2012-06-01 |title=Three-staged correction of severe rigid idiopathic scoliosis using limited halo-gravity traction |url=https://doi.org/10.1007/s00586-011-2111-0 |journal=European Spine Journal |language=en |volume=21 |issue=6 |pages=1091–8 |doi=10.1007/s00586-011-2111-0 |pmc=3366138 |pmid=22160155}} These reasons have led to HGT becoming the standard preoperative treatment for patients with severe spinal deformities.{{Cite journal |last1=Yang |first1=Zhao |last2=Liu |first2=Yang |last3=Qi |first3=Longtao |last4=Wu |first4=Shanshan |last5=Li |first5=Jingwen |last6=Wang |first6=Yu |last7=Jiang |first7=Bin |date=2021 |title=Does Preoperative Halo-Gravity Traction Reduce the Degree of Deformity and Improve Pulmonary Function in Severe Scoliosis Patients With Pulmonary Insufficiency? A Systematic Review and Meta-Analysis |journal=Frontiers in Medicine |volume=8 |doi=10.3389/fmed.2021.767238 |pmid=34901083 |pmc=8655856 |doi-access=free }}

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