Document Type

Article

Publication Date

12-2025

Identifier

DOI: 10.1016/j.semss.2025.101213

Abstract

Severe pediatric spinal deformities may require staged correction strategies to mitigate neurologic risk and optimize cardiopulmonary outcomes. This paper reviews two adjunctive techniques—halo gravity traction (HGT) and temporary internal distraction (TID)—used in the management of rigid scoliosis. HGT enables gradual preoperative spinal elongation and coronal/sagittal realignment, improving pulmonary function and nutritional status while reducing the need for three-column osteotomies. TID offers an internal, staged distraction approach for patients contraindicated for external traction, allowing incremental correction via posterior instrumentation followed by definitive fusion. Clinical studies report Cobb angle reductions of 30–80 %, with low rates of neurologic complications when neuromonitoring and mean arterial pressure protocols are rigorously applied. Technical considerations include halo pin torque settings, traction weight progression, and intraoperative distraction parameters. Both techniques demonstrate efficacy in reducing deformity severity, improving perioperative safety, and enhancing long-term outcomes. Their integration into multidisciplinary care pathways supports safer and more effective surgical management of complex pediatric spinal deformities.

Journal Title

Seminars in Spine Surgery

Volume

37

Issue

4

Keywords

Scoliosis; halo gravity traction; temporary internal distraction

Comments

This article is available under the Creative Commons CC-BY-NC-ND license and permits non-commercial use of the work as published, without adaptation or alteration provided the work is fully attributed.

Publisher's Link: https://www.sciencedirect.com/science/article/pii/S1040738325000577?via%3Dihub

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