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.