Yonsei Med J.  2010 Sep;51(5):648-652. 10.3349/ymj.2010.51.5.648.

Optimal Use of the Halo-Vest Orthosis for Upper Cervical Spine Injuries

• Shin JJ
• Kim SJ
• Kim TH
• Shin HS
• Hwang YS
• Park SK

• KMID: 1071414
• DOI: http://doi.org/10.3349/ymj.2010.51.5.648

Abstract

PURPOSE
Upper cervical fractures can heal with conservative treatments such as halo-vest immobilization (HVI) and Minerva jackets without surgery. The most rigid of these, HVI, remains the most frequently used treatment in many centers despite its relatively high frequency of orthosis-related complications. We conducted this study to investigate the clinical outcome, effectiveness, patient satisfaction, and associated complications of HVI.
MATERIALS AND METHODS
From April 1997 to December 2008, we treated 23 patients for upper cervical spinal injuries with HVI. For analysis, we divided high cervical fractures into four groups, including C1 fracture, C2 dens fracture, C2 hangman's fracture, and C1-2 associated fracture. We evaluated the clinical outcome, complications, and patient satisfaction through chart reviews and a telephone questionnaire.
RESULTS
The healing rate for upper cervical fracture using HVI was 60.9%. In most cases, bony healing occurred within 16 weeks. Older patients required longer fusion time. We observed a 39.1% failure rate, and 60.9% of patients experienced complications. The most common complications were frequent pin loosening (34.8%; 8/23) and pin site infection (17.4%; 4/23). The HVI treatment failed in 66.7% of patients with pin site problems. The patient approval rate was 31.6%.
CONCLUSION
The HVI produced frequent complications and low patient satisfaction. Bony fusion succeeded in 60.9% of patients. Pin site complications showed a tendency to influence the outcome of HVI, and would be promptly addressed to prevent treatment failure if they develop. The decision to use HVI requires an explanation to the patient of potential complications and constant vigilance to prevent such complications and unsatisfactory outcomes.

Keyword

Halo-vest; cervical trauma; bony healing; complication

MeSH Terms

Adult
Aged
Cervical Vertebrae/*injuries
*External Fixators/adverse effects
Female
Humans
Male
Middle Aged
Retrospective Studies
Spinal Injuries/*therapy
Treatment Outcome
Young Adult

Figure

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  Fig. 1 Older patients required proportionately longer time to fuse.

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  Fig. 2 A 61-year-old man suffered from posterior neck pain after a traffic accident. (A) A CT lateral reconstruction image revealed the odontoid fracture. The fractured odontoid process was slightly displaced posteriorly. He underwent the conservative treatment with halo-vest immobilization at his request. (B) After 16 weeks, the patient complained of continued posterior neck pain, although it was reduced compared with that of the initial trauma. On the CT lateral reconstruction image, we found that the fracture site had not completely healed.

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  Fig. 3 A 49-year-old man had severe neck pain after a vehicle collision, and had been previously treated with HVI. (A) The neck pain persisted for 12 weeks while HVI was applied. The lateral plain radiograph showed anterior displacement above the subaxial spine at C2 and an unhealed bony fracture. The axial CT image also showed the bony fractured particles yet unhealed. (B) A posterior fixation was performed at C1-2-3. An axial CT image shows bony healing at 12 weeks after surgery.

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