JBJS Reviews
Cervical Traction for the Treatment of Spinal Injury and Deformity
Joanne H. Wang, BA; Alan H. Daniels, MD; Mark A. Palumbo, MD; Craig P. Eberson, MD
  • Following cervical spine trauma, traction can be used to restore sagittal plane alignment in patients with subaxial injuries, to reduce unilateral or bilateral cervical facet dislocations, and to improve alignment in patients with traumatic spondylolisthesis of the axis.

  • The use of halter or skull traction may obviate the need for operative treatment for some patients with atlanto-axial rotatory subluxation.

  • Perioperative and intraoperative spinal traction has been shown to assist with preoperative planning and to improve overall correction and pulmonary function in patients with spinal deformity.

  • The most common complications associated with cervical spine traction are pin-site irritation and infection; however, more serious neurological complications, including cranial nerve palsy and spinal cord injury, also can occur; thus, careful monitoring of patients undergoing traction is essential.

History of Spinal Traction

As early as the 4th century BCE, Hippocrates described spinal traction as a treatment for kyphotic deformity1. His invention, the scamnum, was a device composed of ropes attached to windlasses that produced traction on the body. This device was used for the treatment of fractures and deformity into the 17th century1. In the 1600s, the German surgeon Fabricius Hildanus described a method for reducing cervical fracture-dislocations by combining traction with open reduction. With this method, the patient was positioned on a stretching bench to extend the cervical spine, after which the surgeon made an incision to expose and grasp the spinous process with forceps. The dislocated vertebrae were then manipulated into physiological alignment2.

While spinal traction techniques did not evolve further until the 20th century, the understanding of spinal anatomy and biomechanics improved during this period, providing the foundation for many of the developments in spinal traction and instrumentation that would occur in the modern era.

In 1929, Taylor introduced the halter device as a method …