• Spine · May 2019

    Halo Gravity Traction Can Mitigate Preoperative Risk Factors and Early Surgical Complications in Complex Spine Deformity.

    • Sravisht Iyer, Oheneba Boachie-Adjei, Henry Ofori Duah, Kwadwo Poku Yankey, Rufai Mahmud, Irene Wulff, Henry Osei Tutu, Harry Akoto, and FOCOS Spine Research Group.
    • Hospital for Special Surgery, New York, NY.
    • Spine. 2019 May 1; 44 (9): 629-636.

    Study DesignRetrospective review of prospective cohort.ObjectiveWe sought to examine the role of halo gravity traction (HGT) in reducing preoperative surgical risk.Summary Of Background DataThe impact of HGT on procedure choice, preoperative risk factors, and surgical complications has not been previously described.MethodsPatients treated with HGT before primary surgery were included. The FOCOS Score (FS) was used to quantify operative risk. FS was calculated using patient-factors (ASIA, body mass index, etiology), procedure-factors (PcF; osteotomy planned, number of levels fused, etc.), and curve magnitude (CM). Scores ranged from 0 to 100 with higher scores indicating increased risk. FS was calculated before and after HGT to see how changes in FS affected complication rates.ResultsA total of 96 patients were included. Halo-related complications occurred in 34% of patients but revision was required in only 8.3%. Average FS improved by 18 points after HGT. CM, PcF, and patient-factors all improved (P < 0.05). The greatest changes were in CM and PcF. The planned rate of three-column osteotomies dropped from 91% to 38% after HGT. FS (area under the curve [AUC]: 0.68, P = 0.023) and change in FS (AUC: 0.781, P < 0.001) was successfully able to predict the rate of surgical complications. A preoperative FS of 74 was identified as a cut-off for a higher rate of surgical complications (sensitivity 58.8%, specificity 74.7%). Patients with a reduction in FS <  = 10pts were five times more likely to have a complication (relative risk 5.2, 95% confidence interval: 1.9-14.6, P < 0.001). A multivariate regression showed that change in FS was an independent predictor of complication rates (P < 0.05).ConclusionFS can successfully predict surgical risk in pediatric patients with complex spinal deformity. Preoperative HGT can reduce FS and surgical risk by improving CM, lowering three-column osteotomies use, and improving body mass index. A reduction in FS after HGT predicts a lower rate of surgical complications.Level Of Evidence3.

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