Home-based halo gravity traction for severe pediatric spinal deformities using a novel protocol

We aimed to evaluate the safety and efficacy of an original structured protocol for preoperative home-based halo gravity traction (HGT) in children with severe spinal deformity.

A treatment protocol for preoperative home-based HGT was developed for children with severe spinal deformity scheduled for posterior spinal fusion. The protocol comprises two phases: Phase 1 (hospital phase, 3-5 days), which includes halo placement, and Phase 2 (home phase), which involves a gradual increase in traction up to 50% of body weight, with weekly clinical, neurological, nutritional, respiratory, and radiographic assessments.

We prospectively evaluated 43 consecutive patients; 40 completed the home-based HGT protocol and were included in the analysis, while three were excluded because hospitalization was required due to traction system failure or need for clinical optimization. The mean age at HGT initiation was 12 years ± 2 years (5.5-18), and 67.5% were female. The mean pre-HGT scoliosis angle was 106° (90-144°), with a mean angular correction of 25° (23.6%). The mean pre-HGT kyphosis angle was 64° (38-81°), with a mean angular correction of 23° (36%). The mean duration of HGT was 14.7 weeks (4-57). Complications occurred in six patients (15%). Most patients were able to maintain their usual educational and social activities in their home communities, and families continued their work routines. These results were compared with findings from previously published studies. The mean treatment cost per patient was 6.5-fold higher for inpatient than for home-based treatment.

The home-based HGT protocol achieved results comparable to those reported for hospital-based traction in the literature. Home-based HGT may represent a viable option in carefully selected patients with adequate family support and the ability to adhere to treatment and follow-up requirements.