Oral Presentation Sydney Spinal Symposium 2024

Halo traction evaluation of Cranio-cervical instability in hereditary connective tissue disorder patients: case series (108193)

Charmain Stewart 1 , Hussain Bohra 1 , Joseph Maalouly 2 , Neha Chopra 1 , Gayani Petersingham 2 , Ashish Diwan 1 , Kevin Seex 3 , Prashanth Rao 1 2 3 4
  1. Spine Service, University of New South Wales, Department of Orthopaedic Surgery, St George and Sutherland Clinical School, SYDNEY, NSW, Australia
  2. Brain and Spine Surgery, BELLA VISTA, NSW, Australia
  3. Department of Neurosurgery, Macquarie University Hospital, MACQUARIE PARK, NSW, Australia
  4. Department of Neurosurgery, Norwest Private Hospital, BELLA VISTA, NSW, Australia

Introduction: Cranio-cervical instability (CCI) is a condition commonly found in patients with connective tissue disorders such as Ehlers-Danlos Syndrome (EDS), leading to various symptoms. Assessing patients for surgical fusion as a treatment for CCI is challenging due to the complex nature of EDS-related symptoms. This study aimed to evaluate the role of pre-fusion Halo traction in alleviating symptoms and determining suitable candidates for fusion surgeries.

Methods: EDS patients (n=21) with neurological symptoms underwent halo traction between 2019 and 2022. Patients completed a CCI Questionnaire before and after the traction, reporting symptoms related to headache, vision, hearing, equilibrium, and pe. Symptom groups were assigned scores based on patient responses, with one point for each affirmative answer. Before and after scores were analyzed using  paired t-test. Patients experiencing over 50% improvement in the majority of symptoms were considered for definitive fusion surgery.  patients subsequently underwent fusion for CCI.

Results: The average age of the patients was , consistent with existing literature. Significant improvements were observed in various symptom group after halo traction, including headache (57% improvement, p < 0.001), brainstem functions (71% improvement, p < 0.001), cerebellar functions (55% improvement, p < 0.001), hearing (63% improvement, p < 0.001), motor functions (51% improvement, p < 0.001), vision (60% improvement, p < 0.001), cardiovascular functions (46% improvement, p < 0.05), sensory and pain (53% improvement, p < 0.001), high cortical functions (54% improvement, p < 0.001), GI functions (52% improvement, p < 0.05), bladder functions (52% improvement, p < 0.05), and Modified Karnofsky score (30% improvement, p < 0.05).

Conclusion: halo traction proved to be a simple and effective method for evaluating patients for surgery while providing symptomatic relief in EDS-related CCI cases. It allows surgeons to monitor patients with a now stable cranio-cervical junctions (CCJ) before committing to surgery.