Iatrogenic biological fracture of the cervical spine during gradual halo traction for kyphotic deformity correction: case report

Abstract

Background: Severe kyphotic deformities carry high risk for neurological injuries as osteotomies are often required for correction. Surgeons often utilize a staged approach for dealing with these conditions starting with a period of halo traction to stretch tight soft tissues and partially correct the deformity, followed by surgery. Halo traction is a relatively safe procedure and complications are uncommon. We report a unique case of iatrogenic fracture of the cervical spine during gradual halo traction for deformity correction of a severe cervical kyphosis.

Case presentation: An 80-year-old female with previous cervical spine tuberculosis infection and C5-C6 anterior spinal fusion developed severe cervical kyphosis of 64° from C2-C6 and neck pain requiring deformity correction surgery. Gradual increase in traction weight was applied, aiming for a maximum traction weight of 45 pounds or half body weight. During the 1st stage halo-gravity traction, sudden neck pain and a loud cracking sound was witnessed during increase of the traction weight to 14 pounds. Imaging revealed a fracture through the C4 and reduction in kyphosis deformity to 11° from C2-C6. There was no neurological deficit. No further traction was applied and the patient underwent an in-situ occipital to T3 fusion without osteotomies. At 3-year follow-up, the patient was symptom-free and radiographs showed solid fusion and maintenance of alignment.

Conclusions: Iatrogenic fracture may occur with halo traction. Elderly patients with osteoporotic and diseased bone should be closely monitored during the treatment. A fracture without complications was a fortunate complication as the patient was able to avoid any high-risk osteotomies for deformity correction.

Level of evidence: IV.

Keywords: Case report; Cervical kyphosis; Deformity correction; Halo traction; Iatrogenic fracture; Osteotomy.

Fig. 1

a Lateral cervical X-ray shows severe kyphotic angle of 64° before traction; b anteroposterior cervical X-ray shows a tilt to the left. c After the iatrogenic fracture at C4, the kyphotic angle improved to 11.2°

Fig. 2

Sagittal CT scan after fracture with the white arrow pointing at the fracture line

Fig. 3

a Lateral cervical X-ray taken immediately postop showing a kyphotic angle of 15.4° from C2–6; b The kyphotic angle maintained at three-years after the anterior and posterior in-situ fusion and instrumentation with solid fusion; c The anteroposterior alignment was improved