Complications in children managed with immobilization in a halo vest.

Dormans, John P.; Criscitiello, Arnold A.; Drummond, Denis S.; Davidson, Richard S.

doi:10.2106/00004623-199509000-00013

Cited by 136 publications

(61 citation statements)

References 9 publications

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“…There were complications noted in 68% of the patients, and those rates were comparable to the rates in the adult population [6,11]. Pin site loosening with or without infection was the most common complication.…”

Section: Discussionsupporting

confidence: 55%

Analysis of halo-orthoses application in children less than three years old

Arkader

Hosalkar

Drummond

et al. 2007

Journal of Children's Orthopaedics

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Purpose To evaluate the safety and efficacy of halo immobilization in children younger than 3 years. Methods All children less than 3 years of age who were placed in a halo-orthosis at a tertiary pediatric center were reviewed to determine the indications, safety, and efficacy of this method. Adequacy of immobilization and correct technique was established considering the chronology of maturation (skull and brain development). The functional outcome was analyzed. Results Ten patients (\3 years old) were identified from a total of 150 where halo ring/vest immobilization was used. There were six boys and four girls, with an average age of 2 years (range 10 months to 2 years and 10 months). The average time of immobilization in the halo-orthosis was 75 days (range 33-168 days), and the average follow-up time was 5 years and 2 months (range 1-12 years). There were two halo-related problems and four related to the index procedure. Halo-related problems included pin-site infection in one patient, and three pins loosening in another. There were four complications associated with the index procedure, all early in the series, including three cases of pseudarthrosis and one patient that had an insufficient decompression of basilar invagination. Two of the three failed fusions occurred at the occipito-cervical junction, which prompted us to develop new techniques for fusion at this level. Conclusions Halo-orthosis is a relatively safe and reliable device for immobilization of the upper cervical spine in children less than 3 years old. Understanding the developmental anatomy and a limited CT scan are helpful in pin placement. We recommend the use of a multiple pin construct, perpendicular insertion, and precise tightening with good pin-site care and frequent follow-up. The benefits seem to outweigh the risks in this population, considering the mechanical advantages of the halo-orthosis.

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Section: Discussionsupporting

confidence: 55%

Analysis of halo-orthoses application in children less than three years old

Arkader

Hosalkar

Drummond

et al. 2007

Journal of Children's Orthopaedics

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“…The halo has a high complication rate in young children, 7 and is seldom used in patients younger than 3 years of age. 9 Therefore, careful evaluation by skull osteology study and multiple-screw techniques are necessary to make the application of the halo easy and safe.…”

Section: Discussionmentioning

confidence: 99%

Occiput-cervical fusion for symptomatic atlantoaxial subluxation in a 32-month-old child with Down syndrome: a case report

Tseng

Cheng

1998

Spinal Cord

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Atlantoaxial subluxation in Down syndrome rarely becomes neurologically symptomatic in very young children. The authors present a 32-month-old girl with Down syndrome, who had tetraporesis due to an atlantoaxial subluxation. She was treated with halo immobilization and partial reduction of the subluxation at ®rst, followed by removal of posterior arch of the atlas and posterior fusion with wire ®xation. Halo immobilization was continued for 3 months after operation. After 1-year follow-up, her motor functions were normal, and the dynamic roentgenogram of the cervical spines showed good stability. The authors recommend posterior fusion and postoperative halo immobilization for the treatment of the symptomatic atlantoaxial subluxation in young Down syndrome patients, even in a 32-month-old child.

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“…9,16,20,24 Perforation of the skull or an enlarged or aberrant frontal sinus with resulting intracranial infection, CSF leakage, and pneumocephalus are uncommon but can occur despite following standard anatomical landmarks. 7,8,11,18,25 Actual dislodgement of the halo from the skull is usually due to a fall. 3,11 A number of minor complications can occur, depending upon the length of halo treatment, in up to 60% of patients-usually pin loosening or local pin site infections.…”

mentioning

confidence: 99%

“…Both of these problems involve the anterior SO rather than posterior pin sites in 60%-70% of patients. 2,8,11,15,20,23 Infections nearly always resolve with antibiotic therapy. The literature on cervical halo vest complications also includes dissatisfaction or unsatisfactory SO scarring in 9%-30% of patients.…”

mentioning

confidence: 99%

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Frontolateral pins for halo ring placement: reassessment of a common neurosurgical procedure with CT measurements of skull thickness

Stone

Gulabani

Gorelick

et al. 2013

SPI

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Object Halo orthosis placement is a common neurosurgical procedure for the treatment of cervical spine injuries. Frontal sinus puncture by the anterior pins may occur using standard techniques, and up to 30% are dissatisfied with forehead scarring, especially women and African Americans. Methods The authors describe a frontolateral (FL) anterior pin site placement supported by high-resolution CT scan skull thickness measurements. The standard supraorbital (SO) pin site is several centimeters above the lateral orbit, whereas the FL pin site is 2–3 cm posterolateral to the SO site. Frontolateral placement is just anterior to the temporalis muscle close to a triangular anterior projection of the temporal hairline. For quantitative information on skull thickness at the SO and FT pin sites, thin 0.625-mm CT scan measurements of the outer table, diploic space, and inner table were obtained in 40 adults (80 sites). Results The mean values for total skull thickness at the SO and FT sites were not significantly different. The inner table was significantly thicker at the FL site in both males and females, buttressed by the nearby greater sphenoid wing. The mean total skull thickness was significantly less in females than in males, but the values were not significantly different at the SO and FL sites. Conclusions The FL and SO anterior pin sites are comparable with respect to skull thickness CT measurements, with a significantly thicker inner table at the FL site. In the senior author's experience, the FL anterior pin site yielded secure fixation without skull perforation, neurovascular injury, or propensity to infection. The cosmetic result of the FL site is more acceptable, and the authors recommend its general usage be adopted.

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Complications in children managed with immobilization in a halo vest.

Cited by 136 publications

References 9 publications

Analysis of halo-orthoses application in children less than three years old

Analysis of halo-orthoses application in children less than three years old

Occiput-cervical fusion for symptomatic atlantoaxial subluxation in a 32-month-old child with Down syndrome: a case report

Frontolateral pins for halo ring placement: reassessment of a common neurosurgical procedure with CT measurements of skull thickness

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