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What
is Traction?
Spinal
traction is a treatment option that is based on the application
of a longitudinal force to the axis of the spinal column.
In other words, parts of the spinal column are “pulled”
in opposite directions in order to stabilize or change the
position of damaged aspects of the spine. The force is usually
applied to the skull through a series of weights or a fixation
device and requires that the patient is either kept in bed
or placed in a halo vest.
History
of Spinal Traction
Physicians
have been aware of the concept of traction for many centuries;
however, it was not heavily explored or used as a therapeutic
option until the late 18th century. At that time, the primary
indications for spinal traction were the correction of scoliosis
and spinal deformity, the management of rickets, and for
relieving backache of any origin or location. Later in the
19th century, attempts were made to treat a multitude of
neurological disorders with spinal traction (including conditions
such as Parkinson’s disease and impotence). Needless to
say, the results were generally not consistent and the technique
did not gain much support among those in the medical community.
By the first half of the 20th century, the accepted uses
of spinal traction became primarily focused in the areas
of cervical spine surgery and, more frequently, in the management
of spinal trauma and pain.
Uses
of Spinal Traction
There
are a number of medically accepted uses for spinal traction,
which include the mobilization of soft tissues or joints,
decompression of pinched nerve roots, and reduction of herniated
intervertebral disks. Currently, the most important use
of traction is for the management of cervical spine instability.
Instability is defined as damage to the cervical spinal
column, either through trauma or disease, resulting in a
potential for shifting/malunion of fractured bones prior
to healing or abnormal movement of the injured region with
a likelihood of additional neurological damage. Traction
is an extremely effective means of realigning a cervical
spinal dislocation and providing stabilization for these
types of cervical spine injury.
Low
weight cervical spinal traction may be beneficial in the
early treatment of cervical radiculopathy caused by a disc
herniation. In these cases, 7 to 10 lbs. of traction is
applied for approximately one hour three times a day. Some
set ups allow the patient to apply the traction in bed while
others hang the weight over a door and the patient is seated
in a chair
How
is Spinal Traction Applied?
Spinal
traction relies on the application of a distractive (“upward”)
force being applied to the skull while the rest of the body
is held in place. The use of a device that is firmly attached
to the skull is required for the successful application
of this force. In the early days of spinal traction, combinations
of straps and harnesses were used that were wrapped around
the head and connected to the mechanism responsible for
applying the force. The drawback to this type of system
was that long-term use of the straps, particularly with
heavy weights, was very damaging to the underlying skin
of the chin and neck. In many cases patients ended up with
pressure sores and serious skin damage following long-term
traction.
Throughout
the middle of the 20th century, advances were made which
utilized hooks or tongs that were firmly attached to the
skull. The main complication from the use of skull tongs
was a possibility for penetration of the skull by the pins
used to attach the tongs to the head. A solution to this
problem appeared in the early 1980’s through an advance
known as the Gardner-Wells tongs. This U-shaped device was
specifically shaped to control pressure at the sites of
pin attachment to the head, thereby significantly decreasing
the risk of damage to the skull. Another device that is
acceptable for the application of spinal traction is the
halo, which is basically a ring that is attached to the
head through a series of four pins. The traction force is
initially applied through both of these devices by fixing
the patient’s torso in bed while a series of weights are
gradually added to the tongs or halo. For patients requiring
long-term treatment, the halo vest is preferentially used
over the Gardner-Wells tongs and bed-based traction.
Harnesses
or slings are still used for the treatment of disc herniations
as mentioned earlier. In these cases the amount of weight
used is low and the time spent in traction is intermittent.
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