Halo-thoracic brace immobilization in 188 patients with acute cervical spine injuries.
ABSTRACT The authors report 188 patients with acute cervical spine injury with fracture who underwent Halo-thoracic brace immobilization. The majority of the fractures were considered unstable. Early neurological assessment revealed 24 patients without neurological deficit. There were 164 patients with associated cervical cord injury; 84 patients with incomplete, and 80 patients with complete tetraplegia. Management consisted of skull traction and application of the Halo-thoracic brace about 1.3 weeks after admission. The average radiological union time was 11.5 weeks following a mean of 10.2 weeks of immobilization in a Halo apparatus. Satisfactory restoration of bone and ligament stability, with no significant posttreatment neck pain, was obtained in 168 cases (89%). This is comparable to the fusion rate achieved for cervical fractures in the literature. The follow-up periods range from 1 month to 6 years, with a mean of 10.8 months. The management and results in 73 patients with unilaterally and bilaterally locked facets with or without fractures are discussed. Complete tetraplegia is not considered a contraindication to Halo apparatus immobilization. The multiple factors responsible for overcoming the barrier of anesthetic skin are elucidated. Use of the Halo apparatus offers early mobilization and rehabilitation without neurological deterioration. Complications are few and insignificant.
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ABSTRACT: We evaluated treatment by posterior approach and its results for unilateral and bilateral facet dislocation of the lower cervical spine. Fracture reduction and ultimate stabilization of low cervical fractures located between C3 and C7 depend on the mechanism of the lesion and the resulting affectation of the osteoligamentary structures. The varied surgical approaches to fractures with unilateral or bilateral luxation include anterior, posterior, and combined. No surgery is performed if a conservative approach is used. Of the 71 low cervical fractures treated in our service in 10 years, 42 were facetary luxations (unilateral in 24 patients and bilateral in 18). Radiological studies included X-ray, CT and, in some cases, MRI. Once cervical fracture was diagnosed, halo traction was initiated and the decision to operate (34 cases) or continue conservative treatment (eight cases) was made a week after admittance. Surgery consisted of the posterior approach (27 bilateral clamps with bone graft, 5 wires with bone graft, and two posterior plates). Average patient follow-up was 7 (range 2-12) years. The patients' neurological status improved in 30 cases (71.42%) and was unchanged in 12 (28.57%). Three of eight patients initially treated conservatively developed radicular pain and instability and underwent surgery. Clamps were placed via a posterior approach in one case and the other two cases required a combined posterior and anterior approach. No instrumentation has required removal, although one patient developed a wall abscess. We found a posterior approach provides good stability for placing an arthrodesis in patients with a unilateral or bilateral cervical dislocation. In most of our cases we used clamps, and there was no worsening of any patient's neurological condition.European Journal of Orthopaedic Surgery & Traumatology 01/2002; 12(3):123-128. · 0.18 Impact Factor
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ABSTRACT: Reported surgical treatment for injuries and instabilities of the paediatric cervical spine most commonly involves posterior fusion with internal fixation, usually posterior wiring.Injury 05/2014; · 2.46 Impact Factor