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Spinal Frontiers · Spine Team & Allied Health · Halo Traction

Halo Traction

Protocols, family guides, equipment and frame designs for halo-gravity traction, for the whole team caring for children in traction.

50 resources · checked 6 Nov 2026

Halo traction, mostly halo-gravity traction before surgery for severe early-onset and neuromuscular deformity: the protocols and family guides hospitals publish, where to buy halo rings and traction frames, and how some hospitals have built their own. We copy no traction weights or timings; follow the linked protocols and your team's own.

Hospital protocols and care plans(4)
Irelandhospital nursing protocol

Halo Gravity Traction for Complex Spinal Deformity - nurse practice guideline (v1, effective 6 Feb 2024)

Children's Health Ireland (CHI) at Crumlin

Equipment and traction-bed set-up (cord/pulley), pin care and torqueing (by orthopaedic team), neuro obs (EWS, GCS, spinal neurovascular checks), bed-to-chair transfers, complications (cranial nerve/motor change, pin infection), escalation and emergency traction removal, traction checklist. Protocol gives weight increments (not copied).

Details

Note: Local protocol; document number 'pending'. Original link childrenshealthireland.ie/documents/2179/... redirects here.

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Irelandhospital nursing care plan

Nursing care plan 14: Traction Care (incl. Halo Traction Bed/Chair)

Children's Health Ireland (Orthopaedics Dept)

Traction types incl. halo; cord/pulley/frame safety checks, two-nurse checks, 4-hourly neuro obs and daily ASIA exam, overnight SpO2 monitoring, pressure areas around ring, transfers.

Details

Note: Issued Dec 2020, review date Dec 2023 - may be past review.

Read →Source checked

USAprogramme page

Scoliosis Traction Program

Children's National Hospital (Washington DC)

Spring-based traction usable standing, in wheelchair or bed; family teaching, NP-led daily care, PT, nutrition, child life, schooling.

Details

Note: Service page.

Read →Source checked

Guides for patients and families(6)
USApatient/family guide

Halo gravity traction - family handout (Jan 2022)

UCSF Benioff Children's Hospital Oakland, Division of Orthopaedic Surgery

Purpose, halo placement, length of stay, pain/headache, care team, daily life, sleep and hygiene, risks (pin infection, nerve injury, scarring), next steps.

Details

Note: Family-facing.

Read →Source checked

USApatient/family guide

Halo-Gravity Traction (KidsHealth for Parents)

Nemours KidsHealth (reviewed by Colleen P. Ditro RN DNP, May 2023)

What HGT is (scoliosis, kyphosis, basilar invagination), placement, pain, care team, daily life, risks, how parents can help. Syndicated by many US children's hospitals.

Details

Note: Family-facing; US context.

Read →Source checked

USApatient/family guide

Halo traction FAQs

Gillette Children's

Purpose, placement, typical duration, mobility equipment, pin care and nerve checks, team, sleep/bathing, scarring, activities.

Details

Note: Page discusses adding weights - do not copy.

Read →Source checked

USApatient/family guide

Halo-gravity traction

Children's Healthcare of Atlanta

Conditions (severe, early-onset, syndromic, neuromuscular scoliosis; kyphosis; cervical instability), procedure, pulley traction, imaging, next steps incl. growing rods.

Details

Note: Family-facing.

Read →Source checked

UKpatient/family guide

Halo gravity traction (information for families)

Great Ormond Street Hospital for Children NHS Foundation Trust

Family guide to halo-gravity traction before spinal fusion: why it is used, conditions treated, preparation, fitting the halo ring under general anaesthetic, living with the halo (pain relief, therapy, pin-site care, washing, sleep, moving around), removal and aftercare, risks, and FAQs including MRI.

Details

Note: Family-facing; no review date shown on the page.

Read →Source checked

UKpatient/family guide

Halo vest system - information for families (2019F0014, Aug 2019)

Great Ormond Street Hospital NHS Foundation Trust

Halo vest (immobilisation): equipment, MRI compatibility, fitting under GA, pin-site and skin care, mobility, school, when to call.

Details

Note: About halo-VEST immobilisation, not halo-gravity traction; dated 2019. GOSH now also has a separate halo-gravity traction page (listed above).

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Consensus, programmes and reviews(11)
USAconsensus guideline

Roye BD et al. Establishing consensus on the best practice guidelines for use of halo gravity traction for pediatric spinal deformity. J Pediatr Orthop 2020;40(1):e42-e48

Peer-reviewed (Delphi consensus; Columbia/US experts)

Delphi + nominal group: 67 consensus items on indications, goals, pre-op evaluation, protocols and complications; 9 areas of equipoise. Level V.

Details

Note: Expert opinion; protocol items include traction parameters - do not reproduce.

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Ghanaconference abstract (resource-limited setting)

Nemani VM et al. Preoperative halo-gravity traction for severe spinal deformities at an SRS-GOP site in West Africa: protocols, complications and results. Spine J 2014;14 (NASS abstract P19)

FOCOS Orthopaedic Hospital, Accra (Boachie-Adjei et al.)

Traction maintained in wheelchair, walker and bed; radiographic schedule; mean ~107 days before definitive surgery; 11 pin-tract infections, no neurological complications.

Details

Note: Conference abstract; frame construction not described. Protocol gives weight increments (not copied).

Read →Source checked

USAhospital news (intraoperative traction)

CHLA: New evidence questions use of traction during scoliosis surgery

Children's Hospital Los Angeles (Heffernan et al., SRS presentation)

62 neuromuscular scoliosis fusions matched with/without intraoperative traction: no difference in curve correction or pelvic obliquity; slightly longer surgery; equivalent complications.

Details

Note: Hospital blog of a meeting presentation; year not stated; traction type (halo-femoral) not specified. No halo-femoral review verified.

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Halo traction in Africa: FOCOS in Ghana and other centres(16)

Prof. Oheneba Boachie-Adjei founded FOCOS (the Foundation of Orthopedics and Complex Spine) in 1998 and its hospital in Accra, Ghana, opened in 2012. The FOCOS group has published the largest African experience of pre-operative halo-gravity traction for very severe deformity, including tuberculous kyphosis and many patients referred from Ethiopia through Dr Rick Hodes. Other African centres have reported their own series. We found no dedicated halo-traction course in Africa; FOCOS runs spine fellowships and visitor programmes.

GhanaPaper

Preoperative halo-gravity traction for severe spinal deformities at an SRS-GOP site in West Africa: protocols, complications, and results

Nemani VM, ..., Hodes RM, Boachie-Adjei O; FOCOS Spine Study Group · Spine (Phila Pa 1976) 2015

The founding FOCOS paper: a retrospective review of a prospective single-centre database describing the modified halo-gravity traction protocol used at FOCOS in Accra (a Scoliosis Research Society Global Outreach Program site) in 29 patients before fusion or growing rods. It reports safe partial correction and notes that post-infectious kyphosis with apical fusion responds poorly to traction.

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GhanaPaper

Halo Gravity Traction Can Mitigate Preoperative Risk Factors and Early Surgical Complications in Complex Spine Deformity

Iyer S, Boachie-Adjei O, et al.; FOCOS Spine Research Group · Spine (Phila Pa 1976) 2019

A retrospective review of a prospective FOCOS cohort (96 patients) that uses the FOCOS Score to measure operative risk before and after traction. It found that traction lowered the risk score and greatly reduced the number of planned three-column osteotomies.

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GhanaPaper

The Use of Halo Gravity Traction in the Treatment of Severe Early Onset Spinal Deformity

Iyer S, Duah HO, et al., Boachie-Adjei O; FOCOS Spine Research Group · Spine (Phila Pa 1976) 2019

A FOCOS series of 30 children with severe early-onset deformity who had traction before growing-rod or guided-growth surgery. It shows that traction can make otherwise unsuitable curves treatable with growth-friendly implants, and it reports mostly minor pin-site complications.

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GhanaPaper

Characterization of complex vertebral transposition (gamma deformity) > 180 degrees: clinical and radiographic outcomes of halo gravity traction and vertebral column resection (VCR)

Boachie-Adjei O, Sacramento-Dominguez C, et al., Hodes R, Pellise F; FOCOS Spine Research Group · Spine Deformity 2021

A prospective consecutive series of 13 patients at FOCOS with extreme 'gamma' vertebral transposition, treated with traction followed by vertebral column resection. It documents good correction, alongside high rates of neuromonitoring alerts and neurological deficits in this rare deformity.

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GhanaPaper

One-stage multiple posterior column osteotomies and fusion and pre-op halo-gravity traction may result in a comparative and safer correction of complex spine deformity than vertebral column resection

Sacramento-Domínguez C, et al., Boachie-Adjei O; FOCOS Spine Research Group · Spine Deformity 2021

A single-centre retrospective review of 72 patients at FOCOS with curves over 100 degrees, treated with traction followed by posterior fusion with posterior column osteotomies and no VCR. It concludes that correction was satisfactory, neurological complications were few, and results compare favourably with published VCR series.

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GhanaPaper

Surgical management of complex post-tuberculous kyphosis among African patients: clinical and radiographic outcomes for a consecutive series treated at a single institution in West Africa

Maziad AM, et al., Boachie-Adjei O; FOCOS Spine Research Group · Spine Deformity 2021

A consecutive series of 57 patients with post-TB kyphosis treated at FOCOS, about two-fifths of whom had preoperative traction before mostly posterior VCR. It reports good clinical and radiographic outcomes in an underserved region, with similar complication rates whether or not traction was used.

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GhanaPaper

The Effect of Prolonged Pre-Operative Halo Gravity Traction for Severe Spinal Deformities on the Cervical Spine Radiographs

Yankey KP, Duah HO, et al., Boachie-Adjei O; FOCOS Spine Research Group · Global Spine Journal 2023 (epub 2021)

A retrospective review of 37 children and adults at FOCOS who had prolonged traction before definitive surgery, with serial cervical radiographs. It found no atlanto-axial instability or harmful change in cervical alignment. Open access.

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TanzaniaPaper

Feasibility of modified halo-pelvic distraction technique in the management of severe spinal deformities in low- and middle-income countries: a pilot study in East Africa

Sabas RR, et al., Härtl R, Ahmad AA · European Journal of Orthopaedic Surgery & Traumatology 2026

A prospective pilot of seven patients with severe scoliosis at Muhimbili Orthopaedic Institute (Dar es Salaam) and KCMC (Moshi), using a modified Ilizarov-type halo-pelvic distraction device before definitive surgery. It reports meaningful correction and two complications that resolved, and calls for wider study in LMICs. This is not a FOCOS paper.

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Ghana / USAOrganisation

FOCOS – Our Story

Foundation of Orthopedics and Complex Spine (FOCOS, US 501(c)(3))

The foundation's history: Dr Oheneba Boachie-Adjei set it up in 1998 with spine mission trips to Ghana, followed by the Watson House clinic and local training (2005) and the opening of FOCOS Orthopaedic Hospital in Accra (2012).

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GhanaOrganisation

FOCOS Orthopaedic Hospital – Research Department

FOCOS Orthopaedic Hospital, Pantang, Accra

The hospital research unit, which monitors patients in preoperative halo-gravity traction and keeps the spine deformity database. It collaborates with the Growing Spine Study Group and the FOX Pediatric Deformity Study Group. The hospital home page is focoshospital.org.

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GhanaTraining

FOCOS Academic Programmes (incl. FOCOS Spine Fellows)

FOCOS Orthopaedic Hospital, Accra

Training routes at FOCOS: academic visitors (observers, visiting clinicians, distinguished educator), FOCOS Spine Fellows, rotations for GCPS and WACS residents, research trainees and FOCOS clinical preceptorships, plus nursing, allied health and medical-student placements. The pages do not describe a dedicated halo-traction course.

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Ethiopia / GhanaPatient story

What is traction?

Dr Rick Hodes / JDC Ethiopia spine programme (rickhodes.org)

A plain-language explainer for patients and donors on ambulatory halo-gravity traction. It states that the programme's Ethiopian patients have it at FOCOS Hospital in Accra, and that more than 100 have been placed in traction before surgery.

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Ethiopia / GhanaPatient story

Final fusion – Ethiopian spine deformity project

Dr Rick Hodes / JDC Ethiopia Medical Team (rickhodes.org)

Describes the Ethiopia–Ghana spine project, run since 2006 in partnership with Dr Boachie-Adjei and FOCOS, with nearly 1,000 surgeries at FOCOS-Ghana and many patients in halo-gravity traction before surgery. Includes individual patient profiles.

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Buying: halo rings, vests and traction systems(6)

The market is small: several well-known halo ranges are no longer distributed. Check current availability and certification with the maker or your supplier.

USA (Chanhassen, MN)

PMT Halo Systems (graphite open/closed-back rings, NeoCerv superstructure, vests incl. paediatric/youth, liners, traction bail)

PMT Corporation

Halo rings, crowns/superstructure, vests and traction bail; 510(k) K090733 (2009) states MR Conditional (1.5 T and 3 T, conditions specified); GUDID paediatric vest kits 'In Commercial Distribution'.

Details

Note: Brochure dated June 2013 hosted by NHS Scotland MRI physics; some GUDID kit records say labelling contains no MRI information - check per component.

Product page →Source checked

USA / Canada (Synetik, Quebec)

TRAXIO Complete - Weight System (halo gravity traction system)

OrthoPediatrics Corp. (Specialty Bracing) with Synetik Group, Inc.

'Non-active, mechanical traction system' with weight-and-pulley mechanism for HGT in infants, children and adolescents, used with a separately cleared halo ring and pin system; for controlled hospital environments. Launched 30 April 2026.

Details

Note: Press release only: no regulatory status, markets or bed/wheelchair/walker mounting stated. Confirm CE/UKCA status before listing for UK/EU readers.

Product page →Source checked

USA

BREMER Halo Crown system

DePuy Spine, LLC (DePuy Synthes)

Bremer halo crowns (e.g. small crown 48-58 cm).

Details

Note: GUDID: 'Not in Commercial Distribution' since 31 Jul 2018 - historical; do not list as purchasable.

Product page →Source checked

USA

Resolve halo rings / Lil' Angel paediatric vest

Össur Americas (formerly Jerome Group)

Resolve open/closed-back ring kits (MR Conditional per GUDID).

Details

Note: GUDID: 'Not in Commercial Distribution' since 28 Feb 2020; no current Össur halo product page found - treat as discontinued unless Össur confirms.

Product page →Source checked

Sweden

Align Halo Gravity Traction

X-MED AB (Västerås, Sweden)

Swedish-made halo-gravity traction system, registered with the US FDA as a Class I non-powered traction apparatus. Reported to be CE-marked and distributed in Europe by Paradigm Spine; we have not yet confirmed either on a maker or distributor page.

Details

Note: Source is a third-party copy of the FDA establishment registration, which shows the registration as active but lists an expiry year of 2025. Ask X-MED or Paradigm Spine for current registration, the CE certificate and instructions for use before buying.

Product page →Source checked

Building your own frame(7)

Some hospitals have built their own wheelchair-, walker- or bed-mounted traction frames. A frame you make and use on patients is a medical device. In the EU, a hospital may make and use its own device only under the conditions of the health institution exemption (MDR Article 5(5)), including that no equivalent CE-marked device meets the patients' needs; in Great Britain, the MHRA describes how in-house manufacture is handled and the limits that apply. Read the regulatory sources below and involve your medical physics or clinical engineering team.

UK

Newcastle Hospitals in-house halo-gravity traction device (2022)

Newcastle upon Tyne Hospitals NHS FT - medical device engineering / regional technical aid service (Mr Paul Rushton, RVI)

Bespoke device designed, tested and manufactured in under six months; weights on a 'sliding carriage' for constant force; interchangeable between wheelchair and walking frame. Technical information shared under a Creative Commons licence; GOSH and others interested.

Details

Note: No regulatory (UKCA/HIE) statement on either page. News: https://www.newcastle-hospitals.nhs.uk/news/newcastle-team-builds-unique-halo-gravity-traction-device-to-allow-life-changing-surgery/ (22 Jul 2022).

Read →Source checked

UK

Nottingham halo gravity traction wheelchair (2025)

Nottingham University Hospitals NHS Trust - Medical Engineering (Mr Mohammed Patel)

Wheelchair allowing patients to stay upright and mobilise during HGT.

Details

Note: News item (19 Mar 2025); no design detail or regulatory statement.

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USA

Yu H, Kim E, Garg S. Development of a spring-based weight system for halo gravity traction for complex pediatric spinal deformity. Spine Deform 2020;8(5):879-884. PMID 32303999

Peer-reviewed technique (Children's Hospital Colorado / Univ. Colorado authors)

Redesign of free-weight HGT wheelchairs and walkers into spring-based systems with stakeholder input; reported lower build cost, better safety and handling.

Details

Note: PubMed page gave abstract without bibliographic block; citation from https://profiles.ucdenver.edu/profile/226485/198/204009. Institution inferred from author profile.

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Italy

Dallasta S. Design of a halo-gravity traction device for the management of spinal deformities in children (MSc thesis, Politecnico di Milano, Dec 2021)

Politecnico di Milano with IRCCS 'Eugenio Medea' (La Nostra Famiglia)

Passive spring configuration on a wheelchair to keep traction steady as posture changes (reported 48-65% less force variation); compares an active motorised option. States no commercial traction devices were then available.

Details

Note: Engineering thesis, not clinical evidence.

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United Kingdom

Newcastle halo-gravity traction device (shared under an open licence)

Newcastle upon Tyne Hospitals NHS Foundation Trust, regional technical aid service

A traction device designed and built in-house at Newcastle at the request of the spinal surgeons and occupational therapists. The trust chose to share the technical information under a Creative Commons licence rather than sell it, and other specialist centres have asked for the files.

Details

Note: Not CE- or UKCA-marked as far as the page states; a hospital making its own copy must meet the in-house manufacture rules described below.

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Regulatory sources

EUofficial EU guidance

MDCG 2023-1 Guidance on the health institution exemption under Article 5(5) of Regulation (EU) 2017/745 and 2017/746 (Jan 2023)

European Commission - Medical Device Coordination Group

Conditions: same institution, no transfer to another legal entity; appropriate QMS; documented justification that no equivalent CE-marked device meets the need (re-reviewed); Annex I GSPR and risk management; documentation; public declaration; information to competent authority; non-industrial scale; review of clinical experience and corrective action.

Details

Note: Guidance, not law. With CE-marked HGT systems/wheelchairs now on the market (see CHI, TRAXIO), the 'no equivalent device' justification becomes harder for self-built frames.

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UK (Great Britain)official UK guidance

General information on the Health Institution Exemption

MHRA

UK MDR 2002 has a statutory HIE only for IVDs (reg. 33); 'The MDR 2002 do not currently include an exemption for general medical devices' - institutions may apply HIE principles if the same conditions and MHRA leading-practice guidelines are met; MHRA intends to legislate. No transfer between legal entities; devices used outside the institution's premises/vicinity are not eligible. Northern Ireland follows separate guidance.

Details

Note: Important for UK readers: a self-built HGT frame used on patients is a general medical device with no statutory GB exemption yet; a frame used at home (outside premises) is outside the HIE.

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How we compile this page

Each entry records what its source states, checked on the date shown. No weights, timings or doses are copied. Inclusion is not an endorsement, and NSpine has no commercial relationship with any maker listed. We re-check this page every quarter. Know a protocol or frame design that should be here? Write to spinalfrontiers@nspine.com.

Not yet confirmed:

  • The market for halo rings is small: several well-known ranges (Bremer, Össur) are no longer distributed. PMT is the main maker we could confirm in distribution.
  • Several hospitals have built their own traction frames; see 'Building your own frame'.
  • Traction tongs: no current maker page was found, so that list rests on regulator records and is provisional.
  • Still to add: family leaflets from more children's hospitals, and Bone Foam, Schaerer and other prone head-positioner makers once their product pages are confirmed.
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