Not all scoliosis patients require surgical intervention, but for severe cases of childhood scoliosis, halo gravity traction and spinal fusion surgery may be recommended. The traction period can last anywhere from three to eight weeks.
Halo-gravity traction is a technique used to minimize the potential risks of spinal fusion surgery. A metal ring is attached to a child’s skull with small pins, and a pulley system with weights is attached to the ring to gently straighten and decompress the spine. Daily life with halo traction is spent in the hospital, so patients can be monitored and weight can be precisely and gradually adjusted.
When scoliosis is severe, it can cause widespread symptoms and may require surgical intervention.
How Does Halo-Gravity Traction Work?
Halo gravity traction is a method used to address severely compressed spines and severe spinal deformities such as kyphosis and scoliosis. The procedure can be used for adults with severe scoliosis, but is far more common in pediatric orthopaedics.
The method involves attaching a lightweight metal halo (ring) to a patient’s skull via small pins. Children are under general anesthesia during the procedure, and a pulley system with adjustable weights is attached to the halo and gently pulls on the cervical spine.
The number of pins used to attach the metal ring depends on the child’s size, and weight is slowly added to stretch and straighten the curved spine.
The goal is to slowly straighten the spine prior to spinal fusion surgery to increase potential efficacy and decrease associated risks.
Daily Life with Halo Gravity Traction
Children remain in the hospital during halo gravity traction, and the pulley system will be attached to the patient’s bed, wheelchair, and walker.
While some patients experience tenderness around the pin sites and headaches in the immediate days following the procedure, discomfort is short term, and because the halo and pulley system is holding the spine and torso in a straighter position, patients may experience some symptom relief.
Weight is carefully and precisely adjusted based on how the scoliosis is responding, and because the cervical spine is being stretched and decompressed, as the spine’s position is improved, it’s easier to remain in an upright position, and breathing may be easier, cardiovascular function may be improved, along with an increased appetite.
The amount of time spent in traction will depend on the severity of the scoliosis and how the spine is responding. Monitoring for progress is part of daily life in the hospital, and daily care involves evaluating the pin sites for signs of infection, occupational therapists helping with daily tasks such as changing clothes, bathing, and improving mobility in a halo wheelchair or walker.
A scoliosis-specific physical therapist can help patients maintain flexibility and core/back muscle strength through regular movement; these are factors that also increase treatment responsiveness and contribute to easier recovery times.
How Active Can Children Be While in Halo Gravity Traction?
Patients are encouraged to spend as much time out of bed as possible during the traction period.
Standing, walking, and low-impact play are recommended for children undergoing halo traction.
The goal of spinal fusion surgery for severe scoliosis is to permanently stabilize the spine, and the spine’s surrounding muscles play a key role in stabilizing the spine through support and healthy posture, so staying active and strong can help with maintaining proper posture, supportive muscles, and the spine’s optimal alignment.
How Do Children Sleep in Halo Traction?
A special bed will be provided for children in halo gravity traction. It can be difficult for children to adjust to sleeping with the halo attached, but a rolled up towel or small pillow can be placed under the neck and head to make it more comfortable.
Does the Halo Leave Scars at the Attachment Points?
Due to the pins attached to the patient’s head, small scars may remain following the halo’s removal, but the scars typically fade over time.
Can Children Come Out of Traction During the Timeframe?
Children need to remain in halo gravity traction for the recommended time period; recommendations are based on the specifics of a patient’s scoliosis including curve severity, progression, type, and pattern.
Children are allowed to come out of traction for short periods of time to allow for bathing, repositioning for comfort, using the toilet, changing clothes, and necessary daily medical care.
When traction has improved the spine’s position the desired amount, spinal fusion surgery is performed.
What Happens During Spinal Fusion Surgery?
There are different types of spinal fusion, but the process and goal is similar: to straighten the spine, stabilize its position, and stop progression.
Spinal fusion surgery can involve the removal of spinal discs that sit between adjacent vertebrae being fused. The vertebrae at the top of the curve are the most unnaturally-tilted, and they are fused into one solid bone, and a surgeon attaches metal rods to the spine to maintain its position.
Because there is no movement in the fused portion, the spine won’t become more unnaturally curved (progress).
Spinal fusion surgery is an invasive procedure that comes with its share of risks, and halo gravity traction may help minimize those risks by preparing the spine for surgery. If the spine is less compressed and straighter by the end of the traction period, there is less of a spinal correction needed with the surgery.
Because the spine has been stretched prior to the fusion, its flexibility can help reduce necessary bone cutting, and because the spine’s surrounding muscles, supportive ligaments, and tissues are gradually loosened while in traction, the rods and pedicle screws attached to the spine aren’t exposed to as much mechanical stress.
Everyone responds to spinal fusion surgery differently, and factors that influence the type of recovery a patient experiences is curve severity, number of vertebrae fused, location of the fusion, whether or not there were any complications during the procedure, the amount of muscle cutting that took place, and a patient’s overall strength prior to the surgery.
Wearing an Orthopedic Vest After Surgery
After halo gravity traction and spinal fusion surgery, children have to avoid high-impact exercise while the fusion site heals and the spine’s surrounding muscles get stronger.
The halo vest is worn when leaving the hospital to hold the child’s head completely still so the spine’s new position can be further supported.
A halo vest is a brace that’s worn around the torso, is lined with sheepskin to prevent skin chafing, and rods attach the brace to the halo to maintain the head’s optimal alignment over the torso, and the cervical spine’s alignment with the thoracic and lumbar sections below.
As strength is built in the neck, the vest is removed and replaced with a brace to support the cervical spine while allowing for small head movements.
A child’s recovery is closely monitored by the spinal surgeon to determine when the brace and halo can be removed and when regular activity can be resumed.
Early Detection and Nonsurgical Scoliosis Treatment Options
I do want to be clear that not all cases of scoliosis require surgical intervention; in fact, when scoliosis is diagnosed and treated early, there are fewer limitations to what nonsurgical treatment can achieve.
There are no treatment outcomes that can be guaranteed, but we do know that childhood scoliosis can progress quickly so needs a proactive response, and we also know that as scoliosis increases, the spine becomes more rigid, less responsive, and more complex to correct.
Parents need to understand that regular scoliosis screening, along with basic awareness of the early signs of scoliosis to watch for, can help many children avoid the risks associated with spinal fusion surgery.
Nonsurgical treatment is best for the spine’s long-term health and may include a combination of scoliosis-specific rehabilitative exercise, corrective 3D bracing, and scoliosis-specific chiropractic care.
Nonsurgical scoliosis treatment success means as much of the spine’s healthy curves as possible are restored so the spine’s balance and alignment is improved, and building up the spine’s surrounding muscle strength and balance for uniform spinal support stabilizes the spine’s healthier position.
Conclusion
Many patients with scoliosis don’t require spinal surgery. When childhood scoliosis is diagnosed and treated early, a patient’s spine can be highly responsive, but if severe and/or if left untreated and progression past the surgical threshold occurs, spinal fusion surgery may be recommended.
For complex and severe curves, halo gravity traction may also be recommended to prepare the spine for surgery.
Halo gravity traction applies gently stretching to the cervical spine via a halo attached to the skull that’s attached to a weighted pulley system. A patient’s body weight is used, and as weight is added and gradually increased, the body and spine are held in a straighter upright position.
Decompressing the spine also increases its flexibility, for more responsiveness, and while some initial discomfort is common following the halo’s attachment to the skull, discomfort is temporary, and some patients find their symptoms are reduced while in traction.
When considering a child’s severe scoliosis treatment options, professional guidance is needed to determine whether monitoring, nonsurgical treatment, or a combination of halo gravity traction and spinal fusion surgery is the best option.
Here at the Scoliosis Reduction Center®, patients are comprehensively assessed, and when appropriate, treatment is started early with the goal of preventing progression and the need for future spinal surgery.
