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Purpose <p>Osteogenesis Imperfecta (OI) is a rare connective tissue disorder often associated with severe, brace-resistant scoliosis. Posterior spinal fusion (PSF) with pedicle screws can achieve up to 60% coronal correction, while preoperative halo-gravity traction (HGT) may provide additional benefits but carries potential risks. This study evaluated whether HGT offers perioperative or radiographic advantages compared with PSF alone in pediatric OI patients.</p> Methods <p>Thirty-six patients treated between 2002 and 2020 with ≥ 2&#xa0;years’ follow-up were retrospectively analyzed. Patients were divided into HGT + PSF (<i>N</i> = 19) and PSF-only (<i>N</i> = 17) groups, comparable in baseline characteristics. The primary outcome was coronal correction rate (CR); secondary outcomes included operative time, blood loss, length of stay (LOS), complications (Modified Clavien–Dindo–Sink Classification, MCDS), and loss of correction at follow-up. Statistical comparisons used Mann–Whitney <i>U</i> and Chi-Squared tests (<i>p</i> &lt; 0.05).</p> Results <p>Postoperative major and minor curve CR were 60.2% and 66.5% in the HGT + PSF group vs. 55.1% and 37.7% in PSF (<i>p</i> = 0.337 and <i>p</i> = 0.003). At last follow-up, CR was 51.1% and 38.8% for HGT + PSF vs. 44.9% and 25.2% for PSF (<i>p</i> = 0.298 and <i>p</i> = 0.238). Mean blood loss (1235 vs. 1368&#xa0;mL, <i>p</i> = 0.972), operative time (443 vs. 410&#xa0;min, <i>p</i> = 0.490), and LOS (12.6 vs. 9.5&#xa0;days, <i>p</i> = 0.186) were not significantly different. Complications occurred in 57.9% of HGT + PSF vs. 29.4% of PSF patients (<i>p</i> = 0.367), with more major complications in the HGT + PSF group.</p> Conclusions <p>In this cohort, HGT provided only modest additional coronal correction without clear perioperative advantages compared with PSF alone. Given these limited and partly transient effects, its routine use should be considered cautiously and in the context of individual patient characteristics. Larger prospective multicenter studies are needed to clarify the specific clinical scenarios in which preoperative HGT may offer meaningful benefit in the surgical management of OI-related scoliosis.</p>

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Impact of preoperative halo-gravity traction on radiographic and surgical outcomes following posterior spinal fusion in osteogenesis imperfecta: a comparative study

  • 期刊论文

  • 发表日期：

    2026年1月14日

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  • Paolo Brigato,
  • Salim Al Rawahi,
  • Yousef Aljamaan,
  • Oded Rabau,
  • Kai Sheng,
  • Neil Saran,
  • Jean Albert Ouellet

摘要

Purpose

Osteogenesis Imperfecta (OI) is a rare connective tissue disorder often associated with severe, brace-resistant scoliosis. Posterior spinal fusion (PSF) with pedicle screws can achieve up to 60% coronal correction, while preoperative halo-gravity traction (HGT) may provide additional benefits but carries potential risks. This study evaluated whether HGT offers perioperative or radiographic advantages compared with PSF alone in pediatric OI patients.

Methods

Thirty-six patients treated between 2002 and 2020 with ≥ 2 years’ follow-up were retrospectively analyzed. Patients were divided into HGT + PSF (N = 19) and PSF-only (N = 17) groups, comparable in baseline characteristics. The primary outcome was coronal correction rate (CR); secondary outcomes included operative time, blood loss, length of stay (LOS), complications (Modified Clavien–Dindo–Sink Classification, MCDS), and loss of correction at follow-up. Statistical comparisons used Mann–Whitney U and Chi-Squared tests (p < 0.05).

Results

Postoperative major and minor curve CR were 60.2% and 66.5% in the HGT + PSF group vs. 55.1% and 37.7% in PSF (p = 0.337 and p = 0.003). At last follow-up, CR was 51.1% and 38.8% for HGT + PSF vs. 44.9% and 25.2% for PSF (p = 0.298 and p = 0.238). Mean blood loss (1235 vs. 1368 mL, p = 0.972), operative time (443 vs. 410 min, p = 0.490), and LOS (12.6 vs. 9.5 days, p = 0.186) were not significantly different. Complications occurred in 57.9% of HGT + PSF vs. 29.4% of PSF patients (p = 0.367), with more major complications in the HGT + PSF group.

Conclusions

In this cohort, HGT provided only modest additional coronal correction without clear perioperative advantages compared with PSF alone. Given these limited and partly transient effects, its routine use should be considered cautiously and in the context of individual patient characteristics. Larger prospective multicenter studies are needed to clarify the specific clinical scenarios in which preoperative HGT may offer meaningful benefit in the surgical management of OI-related scoliosis.