Halo–Brace: a new halo traction technique for preoperative correction of pediatric severe and rigid spinal deformities

Introduction
Halo-Traction (HT) is a useful technique to reduce curve magnitude and improve pulmonary function in severe and rigid pediatric spinal deformity. It allows a progressive correction of the deformity reducing the risk of neuro-vascular complications of high-grade osteotomies and rapid and extensive one stage surgery. HT can be applied preoperatively, intraoperatively or in-between surgical times of staged procedures. Various type of HT are possible depending on the counter-traction through femur, pelvis or body weight (gravity). The Halo–brace (HB) is a type of HT we recently devised. The aim of this study is to describe the HB and present our preliminary results, highlighting some advantages compared to other halo traction systems.

Materials and Methods
Halo-Brace (HB) is a pelvic traction with a counter-traction through a thermoplastic custom-made brace. Halo is fixed to the brace through 4 carbon/metal telescopic shafts; shafts’ length can be adjusted screwing/unscrewing the metal ferrule on each shaft millimetrically.
Since December 2016, 7 cases of severe and rigid spinal pediatric deformities, treated with preoperative HB prior to corrective surgery. were reviewed. The inclusion criteria were age between 10 and 18 years old; a main rigid scoliotic and/or kyphotic curve over 100°, irrespective of etiology. Patients with an history of spinal surgery were excluded.

Results
7 patients (4 idiopathic scoliosis and 3 syndromic scoliosis) with a mean age of 14.2 y.o. (10-18 y.o.) were included. Traction was applied for a mean of 56.5 days (range 51-61), shafts were distracted daily (about 1-3 mm per day). In two cases, after 1 month of traction, a posterior release was indicated because of a radiographic unsatisfactory correction. All the patients were able to walk during traction time.
At the end of traction treatment, before surgical correction, main scoliosis and kyphosis have a mean correction rate of the Cobb angle of 32.1% and 40.4%, respectively. During HB traction, no neurological complications were recorded. One patient developed an iliac decubitus that healed with routinely medications. No patients were discontinued from traction earlier than planned.

Discussion and Conclusions
HB seems to be a safe and effective technique of HT. Our preliminary results are similar to other halo pelvic or femoral traction systems. The advantages of HB are to permit an easy and millimetric modifiable traction intensity (according to the spinal deformity and patient’s compliance) and to provide a steady and continuous traction irrespective of patient’s posture and ambulation.