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Bram Verhofste MD, Michael Timothy Hresko MD, John Emans MD, Michael Glotzbecker MD,
Brian Snyder MD PhD, Craig Birch MD, Nora O’Neill BA, Lawrence Karlin MD,
Mark Proctor MD, Daniel Hedequist MD
Halo-Gravity Traction for the Treatment of Cervical Spine Disorders
13th International Congress on Early Onset Scoliosis November 20-22, 2019 – Atlanta, GA
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Disclosures
I have no relevant financial relationships with the manufacturer(s) of any commercial product(s) and/or provider(s) of commercial services
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Case ExampleIssues- Young age (size, compliance)- Neurologic deficits - Poor head control- Significant kyphosis
1 yo M w/ NF1 + rhabdoid tumor - Tumor resection + laminectomies - CT + RT
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Case2 years laterExperimental CT Loss of head control + ambulation Failed bracing
ProblemsLoss of posterior elementsSmall anatomyRadiated bone- Poor quality- Poor growth potential
Definitive solution ??
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CaseHGT 25d PostopIn-traction CT Clinically
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Objectives
1. HGT efficacy
2. Safety + complications
3. Protocol for pediatric cervical spines disorders
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MethodsStudy Design: Retrospective cohortInclusion - Age <25 years - Cervical spine deformity- HGT
Data- Correctability- Mod. Clavien-Dindo-Sink classification
Cervical deformity
Cervical kyphosisAtlantoaxial rotatory subluxationBasilar invaginationOs odontoideumCervical arthritis causing deformity
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Methods: HGT ProtocolTraction Details- Halo-crown w/ 4-8 pins - 1-2 lbs / day- 20%-50% BW- Pin-site care / neuro exams
Duration- Variable - 24/7 traction (excl. bathroom / shower)- No activity restrictions
** n=3 HVGT
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Results: Demographics
12
76
21
0
10
Kyphosis ARS BI Os Arthritis
Diagnosis
Cohort: 28 cases (mean 11.3 yo)
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Results: HGT DetailsOutcomes
Characteristic Mean IQR
% Body weight (kg) 29% 19%-40%
HGT duration (days) 25 13-29
Length of stay (days) 35 17-43
Surgical stabilization (n; %) 25 89%
Pre HGT 3w Postop
Pre HGT 2w Postop
Pre HGT 3d
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Results: HGT Efficacy
20
40
60
80
100
120
Presentation End HGT Postop Final FU
Kyphosis
-5
-3
-1
1
3
5
7
Presentation End HGT
Basilar Invagination
4.9mm
0.3mm56°
91°
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Methods: HGT Complications9 AE (32%)
Grade I- 4 pin-site infections (14%)- 4 transient paresthesia's (14%)
Grade II- 1 flaccid paralysis (4%)- (T21 w/ Os, SCC, and myelopathy)
Minimal clinical relevance
Weight removal + Reduced progression
No major Grade III-V AE’s
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Limitations
Limitations
Retrospective
Patient Selection?
Cost-Effectiveness?
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Conclusions
Efficacious + safe
Grade I AE’s
Decreased surgical difficulties
Additional tool
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Thank you!
Future reading