Halo traction evaluation of craniocervical instability in hereditary connective tissue disorder patients: Case series

Hussain Bohra; Joseph Maalouly; Chopra Neha; Charmian Stewart; Ashish D Diwan; Gayani Petersingham; Kevin Seex; Prashanth J Rao

doi:10.1016/j.jocn.2024.110957

Halo traction evaluation of craniocervical instability in hereditary connective tissue disorder patients: Case series

J Clin Neurosci. 2024 Dec 6:132:110957. doi: 10.1016/j.jocn.2024.110957. Online ahead of print.

Authors

Hussain Bohra¹, Joseph Maalouly², Chopra Neha¹, Charmian Stewart¹, Ashish D Diwan¹, Gayani Petersingham³, Kevin Seex⁴, Prashanth J Rao⁵

Affiliations

¹ Spine Service, Department of Orthopaedic Surgery, St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW, Australia.
² Brain and Spine Surgery, Bella Vista, NSW, Australia; Norwest Private Hospital, Dept of Neurosurgery, NSW, Australia.
³ Brain and Spine Surgery, Bella Vista, NSW, Australia.
⁴ Macquarie University Hospital, Dept of Neurosurgery, NSW, Australia.
⁵ Brain and Spine Surgery, Bella Vista, NSW, Australia; Norwest Private Hospital, Dept of Neurosurgery, NSW, Australia; Macquarie University Hospital, Dept of Neurosurgery, NSW, Australia; University of New South Wales, Sydney, NSW, Australia. Electronic address: prashanthdr@gmail.com.

PMID: 39644519
DOI: 10.1016/j.jocn.2024.110957

Abstract

Introduction: Craniocervical 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-vest traction in alleviating symptoms and determining suitable candidates for fusion surgeries.

Methods: EDS patients (n = 21) with neurological symptoms underwent insertion of halo-vest traction between 2019 and 2024. Patients completed a CCI Questionnaire before and after the halo-vest traction, reporting symptoms related to headache, vision, hearing, equilibrium, and function. Symptom groups were assigned scores based on patient responses, with one point for each affirmative answer. Before and after scores were analyzed using paired Student's t-test. Patients experiencing over 50 % improvement in the majority of symptoms were considered for definitive fusion surgery. 16 out of 21 patients subsequently underwent fusion for CCI.

Results: The average age of the patients was 35 years, with a female-to-male ratio of 20:1, consistent with existing literature. Significant improvements were observed in various symptom groups after halo-vest 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-vest 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 post halo stable craniocervical junctions (CCJ) before committing to surgery.

Keywords: Craniocervical instability; Ehlers-Danlos Sydnrome; Halo-vest traction; cervical traction.