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.
"It has been reported that the average radiological union time of cervical spine injuries in a series of 188 patients (age range 15–40 years) was 11.5 weeks following immobilization in a Halo Vest . Obviously, in a patient under the age of 2 years, the healing process of injured tissues is relatively fast compared to older patients. "
[Show abstract][Hide abstract] ABSTRACT: Background: Reported surgical treatment for injuries and instabilities of the paediatric cervical spine most commonly involves posterior fusion with internal fixation, usually posterior wiring. Purpose: To present a new simple technique of stabilization without fusion of the upper cervical spine of young children. Study design: A technical report. Methods: Detailed description of the surgical procedure carried out for stabilizing an unstable flexion-distraction injury in a 23 month-old toddler, with severe head injury and pneumothorax is presented. Results: A rare unstable flexion-distraction injury in the upper cervical spine of a toddler was successfully treated with a posterior Number 2 Vicryl (polyglactin 910) suture fixation, with good healing of the ligaments and endplates, without fusion. Preservation of motion was achieved without obvious instability at 63 months post-surgery. Conclusions: In selected cases of cervical spine injuries in the young paediatric population, a limited approach to the injured spinal segments and simple stabilization using suitable degradable sutures, can provide sufficient stability until healing occurs. Advantages: fusion is avoided, growth disturbances are prevented and spinal motion maintained.
"Neurological deficit is present in approximately 40% of patients and in approximately 10% of traumatic cord injuries, no radiographic evidence is revealed. Treatment choices for such lesions include prolonged bed rest, orthotic support and internal surgical stabilization [3-5]. In this case, our patient was treated conservatively by means of a Halo vest[6,7]. "
[Show abstract][Hide abstract] ABSTRACT: We present the case of a nineteen year old male, who sustained a fracture of anterior-superior surface of C7, combined with anterior subluxation at the level of C6–C7 vertebrae. After x-ray and CT examination, he was treated conservatively by a Halo-vest. After mobilization, the patient was discharged from the hospital with instructions to visit the outpatient's clinic at regular bases.
Despite of our instructions, he did not attend the regular follow-up and, three months later, he visited the emergencies complaining of pin loosening and serious headaches. He was admitted to the clinic in order to perform blood tests and new radiological control. During the first day, high fever (over 38,5°C) was added to his symptoms. Blood exams were indicative of inflammation. Further investigation with CT-scan revealed the presence of a subdural abscess. After consulting the neurosurgeon, the patient was treated conservatively with antimicrobial drugs. Three weeks later he returned home without any symptoms. Since then, he is visiting regularly our clinic and no problems occurred during follow-up.
"Although this is an effective and relatively safe procedure , Kang and co-workers felt that familiarity with the design, rationale of usage, proper method of application, and awareness of potential complications could minimize the morbidity associated with the use of the halo vest device . "
[Show abstract][Hide abstract] ABSTRACT: Specialisation in spinal services has lead to a low threshold for referral of cervical spine injuries from district general hospitals. We aim to assess the capability of a district general hospital in providing the halo vest device and the expertise available in applying the device for unstable cervical spine injuries prior to transfer to a referral centre.
The study was a postal questionnaire survey of trauma consultants at district general hospitals without on-site spinal units in the United Kingdom. Seventy institutions were selected randomly from an electronic NHS directory. We posed seven questions on the local availability, expertise and training with halo vest application, and transferral policies in patients with spinal trauma.
The response rate was 51/70 (73%). Nineteen of the hospitals (37%) did not stock the halo vest device. Also, one third of the participants (18/51, 35%, 95% confidence interval 22 - 50%) were not confident in application of the halo vest device and resorted to transfer of patients to referral centres without halo immobilization.
The lack of equipment and expertise to apply the halo vest device for unstable cervical spine injuries is highlighted in this study. Training of all trauma surgeons in the application of the halo device would overcome this deficiency.
Journal of Trauma Management & Outcomes 02/2007; 1(1):6. DOI:10.1186/1752-2897-1-6
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