Jain MA, Dhawale A, Iqbal MZ, Naseem A, Sagade B, Gorain A, Nene A. Halo gravity traction for pediatric scoliosis and kyphoscoliosis: A review of current evidence and best practices. World J Orthop 2025; 16(12): 110510 [DOI: 10.5312/wjo.v16.i12.110510]
Corresponding Author of This Article
Meet A Jain, Postdoctoral Fellow, Department of Pediatric Orthopedics, Bai Jerbai Wadia Hospital for Children, Acharya Donde Marg, Parel, Maharashtra 400012, Mumbai, India. meetjain2295@gmail.com
Research Domain of This Article
Orthopedics
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Minireviews
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dec 18, 2025 (publication date) through Dec 17, 2025
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Journal Information of This Article
Publication Name
World Journal of Orthopedics
ISSN
2218-5836
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Jain MA, Dhawale A, Iqbal MZ, Naseem A, Sagade B, Gorain A, Nene A. Halo gravity traction for pediatric scoliosis and kyphoscoliosis: A review of current evidence and best practices. World J Orthop 2025; 16(12): 110510 [DOI: 10.5312/wjo.v16.i12.110510]
Meet A Jain, Arjun Dhawale, Md Zafar Iqbal, Bhushan Sagade, Department of Pediatric Orthopedics, Bai Jerbai Wadia Hospital for Children, Maharashtra 400012, Mumbai, India
Atif Naseem, Apurba Gorain, Abhay Nene, Department of Orthopedics, Lilavati Hospital and Research Centre, Maharashtra 400050, Mumbai, India
Co-corresponding authors: Meet A Jain and Arjun Dhawale.
Author contributions: Jain MA and Dhawale A jointly managed all pre-publication and post-publication communications and activities, thereby ensuring the accuracy and accountability of the published work; Jain MA, Iqbal MZ, Naseem A, Sagade B, and Gorain A were involved in the preparation of the manuscript; Jain MA, Iqbal MZ, and Naseem A performed the literature review; Dhawale A is the invited author and conceptualized the manuscript, along with manuscript editing; Nene A was involved in manuscript editing. Jain MA and Dhawale A contributed equally to this manuscript and are co- corresponding authors. All authors have read and approved the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Meet A Jain, Postdoctoral Fellow, Department of Pediatric Orthopedics, Bai Jerbai Wadia Hospital for Children, Acharya Donde Marg, Parel, Maharashtra 400012, Mumbai, India. meetjain2295@gmail.com
Received: June 9, 2025 Revised: July 9, 2025 Accepted: October 20, 2025 Published online: December 18, 2025 Processing time: 192 Days and 17.6 Hours
Abstract
The surgical treatment of severe scoliosis and kyphoscoliosis in the pediatric population is complicated and has high morbidity and mortality risks. Severe scoliosis has traditionally been defined by a coronal Cobb angle of greater than 90° or 100°. The usual corrective methods for these patients have been anterior or posterior release and osteotomies using a combined anterior-posterior or posterior-only approach. Many of these patients have pre-existing pulmonary compromise; therefore, an anterior approach is often not reasonable or possible. Acute correction of a deformity may also cause neurologic injury. Halo gravity traction (HGT) allows for progressive, gradual, and sustained correction of the spinal deformity in the coronal, sagittal, and axial planes, leading to a decrease in the amount of correction needed at definitive posterior fusion. This relates to decreased postoperative neurologic deficit and improved pulmonary function. Preoperative HGT has evolved to be the surgical adjunct in the treatment of severe spinal deformity. Indications for HGT, best protocols of application, and optimal duration of traction still lack uniformity; thus, a review of the literature remains relevant and necessary. This review summarizes the existing literature on HGT, including its indications, applications, duration of traction, and associated complications.
Core Tip: Halo gravity traction (HGT) provides a safe and gradual approach to more severe scoliosis and kyphoscoliosis in the pediatric population, while decreasing the risk of surgery, as well as improving spinal flexibility, pulmonary function, and nutritional status. It minimizes the need for extensive procedures like vertebral column resection. Even though protocols do vary, there is initial evidence to support 3-11 weeks of traction, and to monitor carefully for pin-site complications as well as neurological complications for monitoring of HGT in children. Overall, HGT serves to improve surgical safety and or outcome for children with complex spinal deformities.
