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Spinal Traction
Summary of Key Points
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Spinal traction is an important treatment adjunct for cervical fractures, dislocations, destabilizing conditions, and deformity.
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Methods of spinal traction include head halter traction, Gardner–Wells tongs, and cranial halos.
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The most common indication for weighted traction is the treatment of cervical facet dislocation.
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When applying traction to a patient with a cervical injury, the patient must be followed with serial clinical examinations and radiographs to monitor for changes in neurological condition and spinal alignment.
Spinal traction is an important treatment adjunct for numerous spinal conditions that uses longitudinal force to restore spinal alignment, achieve indirect spinal cord decompression, and provide stabilization. Traction may be used as a stand-alone therapy or may be used as a bridge until definitive surgical stabilization is possible. Spinal traction has been in use since the 4th century bc , when the Greek physician Hippocrates invented devices to reduce fractures and restore spinal alignment in patients with scoliosis. In the 17th century, the German surgeon Fabricius Hildanus described a novel method for reducing cervical fracture-dislocations that involved placing a needle under a cervical spinous process, which was attached to forceps and placed under traction. Modern traction strategies can be traced to 1929, when A.S. Taylor used a halter device to apply traction in reducing a cervical dislocation before immobilizing the patient in a plaster jacket for 3 to 4 weeks. In the mid 20th century, traction was seen as a safer alternative to manual reduction of cervical fractures, which was still in use at the time. During this period, Crutchfield further developed traction techniques for cervical injuries and developed tongs that were inserted into the skull for this application. The halo device, which consists of a halo ring placed around the head fixed to a rigid body cast, was first described in 1959 as a treatment for arthrodesis of the cervical spine in polio patients and later adapted for use in cervical spine injuries. Today, traction remains an effective and widely used method to reduce fracture dislocations in the cervical spine. In contrast, the role of traction in the conservative management of lumbar spine pathology is unclear, and its use has not been supported by data from prospective clinical studies. The purpose of this chapter is to review the indications for spinal traction in the management of spinal disorders, including the cervical, thoracolumbar, and pediatric spine, and to discuss specific techniques for applying traction to the spinal column.
Indications for Use
Indications for the use of traction in the cervical spine include facet dislocation, lateral mass fractures, displaced odontoid fractures, rotatory atlantoaxial subluxation, kyphotic deformity, and other destabilizing infectious, neoplastic, and autoimmune cervical spine conditions. Relative contraindications to cervical traction are extension distraction injuries, atlantooccipital subluxation or dislocation, young age (<3 years), and type IIa and IIIa hangman fractures. Extension injuries are particularly unstable, and weighted traction may result in an undesirable degree of interspace distraction. Traction may produce changes in neurological examination in a patient with an unstable spinal injury. Hence, traction may entail risk in patients with depressed levels of consciousness who cannot be monitored clinically. Similarly, care should be taken to not oversedate patients undergoing traction.
Head Halter Traction
The head halter device provides a noninvasive means of applying traction to the cervical spine. Indications for head halter traction include atlantoaxial rotatory subluxation (AARS), stable cervical fractures, and conservative management of neck pain and cervical radiculopathy. The head halter devices consists of two pads, placed under the chin and occiput, attached to a rope connected to a pulley and weights. The device may be used in the inpatient setting or at home, although the patient must have the pads properly fitted to ensure even distribution of force to both pads.
In a study of 40 children with AARS, treatment with a cervical collar was effective in reducing subluxation in 21 patients, and of the seven patients requiring halter traction, four patients demonstrated progression of subluxation and required halo traction. In a study of 14 children with acute AARS, all patients experienced spontaneous reduction with a cervical collar and bed rest without the need for halter traction, suggesting that most patients with acute AARS do not require halter traction to achieve reduction.
In a retrospective review of 81 patients with cervical radiculopathy treated with 8 to 12 pounds of halter traction applied for 15 minutes three times per day for 3 to 6 weeks, 78% of patients experienced significant or complete resolution of painful symptoms. Halter traction may also be used to reduce stable cervical fractures. In a study of 20 patients with traumatic spondylolisthesis, fracture union was achieved at a mean of 13 weeks.
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