COMPLICATIONS OF PROLONGED HALO-GRAVITATIONAL TRACTIONAL IN SPINAL DEFORMITY SURGERIES

ABSTRACT Objective: Spinal traction by a cranial halo is a method with more than half a century of application, presenting the possibility of gradual correction of deformities while the patient is awake, also improving respiratory and nutritional patterns. This study aimed to evaluate the complications of pins and traction during their use in treating severe spinal deformities. Methods: We evaluated 27 patients undergoing surgical treatment using halo-gravitational traction pre or interoperatively between 2014 and 2020. Inclusion criteria were the presence of severe deformity (>100º) in the coronal and/or sagittal plane and traction for at least seven days. Two subgroups were identified: patients presenting only severe coronal deformity (Group 1) and patients with severe deformity in the sagittal plane accompanied by coronal deformity (Group 2). Clinical and radiological data were analyzed retrospectively, evaluating the variables: age, sex, weight, height, etiological diagnosis, number of pins, traction time, sagittal and coronal Cobb angle before and after traction, and complications related to pins and traction. Results: Age and weight showed a significant correlation with the occurrence of complications related to the pins (p=0.007; p<0.001), as well as the congenital etiology of deformity (p=0.001), and those patients in group 2 (p=0.006). There was no significant correlation between the variables studied and the occurrence of neurological complications. Conclusion: Halo-gravitational traction is an important adjunctive method in treating severe spinal deformities. Despite having a considerable complication rate, there were no serious events. Level of evidence IV; Case series.

摘要
目的：颅骨环牵引（cranial halo traction）是一项应用逾半个世纪的治疗技术，可在患者清醒状态下逐步矫正脊柱畸形，同时改善呼吸与营养状态。本研究旨在评估颅骨环牵引钉及牵引操作在治疗重度脊柱畸形过程中出现的并发症。
方法：本研究回顾分析了2014年至2020年间，27例术前或术中采用颅骨重力牵引（halo-gravitational traction）进行手术治疗的患者。纳入标准为冠状位及/或矢状位存在＞100°的重度脊柱畸形，且牵引时长至少7天。将患者分为两个亚组：仅存在重度冠状位畸形者（组1），以及同时合并矢状位与冠状位重度畸形者（组2）。对临床与放射学数据进行回顾性分析，评估变量包括：年龄、性别、体重、身高、病因诊断、牵引钉数量、牵引时长、牵引前后的矢状位与冠状位Cobb角，以及与牵引钉和牵引相关的并发症。
结果：年龄、体重与牵引钉相关并发症的发生存在显著相关性（p=0.007；p<0.001），畸形的先天性病因（p=0.001）以及组2患者（p=0.006）同样与此显著相关。本研究未观察到所评估变量与神经并发症的发生存在显著关联。
结论：颅骨重力牵引是治疗重度脊柱畸形的重要辅助手段。尽管该方法的并发症发生率较高，但未出现严重不良事件。证据等级为IV级；病例系列研究。