Outcomes of Halo Immobilization for Cervical Spine Fractures

Abstract

Study Design: Retrospective. Objectives: To evaluate complications and outcomes of halo immobilization in patients with cervical spine fractures treated at a level I trauma center. Methods: A retrospective evaluation of patients treated at a single institution with halo immobilization from August 2000 to February 2016 was performed. Demographic information, mechanism of injury, level and type of spine fracture, length of halo immobilization, complications associated with halo immobilization, and length of patient follow-up were collected. Results: A total of 189 patients treated with halos were identified. Of the 189 patients, 121 (64%) received halos for the management of cervical spine fractures and were included in the study. A total of 49.6% were males and 50.4% were females. The average age was 50.8 years (range 1-89 years). Overall, 10.7% sustained C1 fractures, 71.1% C2 fractures, and 18.2% subaxial spine (C3-C7) fractures. In all, 47.1% of the upper cervical fractures were either odontoid or hangman-type fractures. A total of 25.1% of patients had multiple cervical fractures. At latest follow-up, 81% had healed fractures with good alignment, minimal pain, and return to normal activities. There was an 8.3% mortality rate. The mortality group had an average age of 64.7 years (range 19-84 years). A total of 10.7% of patients failed halo immobilization and 46.3% of patients had complications such as pin site infections (5.8%), loose pins (1.7%), neck pain (20.7%), decreased range of motion (14%), thoracic skin ulcers (2.4%), and dysphagia (1.7%). Conclusions: The use of halo immobilization for cervical spine fractures resulted in clinical success in 81% of patients. Complication rates in geriatric patients were lower than previously reported in the literature.

Subaxial Cervical Spine Injuries: WFNS Spine Committee Recommendations

“…5). 43 Distraction flexion injuries are the most common injury pattern seen in the subaxial cervical spine and commonly occurs in young males. Facet injuries are typically the result of a flexion and distraction injury and may contain an element of rotation.…”

Predictors of 30-Day Unplanned Readmissions, Complications, and Mortality Following Operative Management of C2 Fractures

“…In our clinical practice at a level-I trauma center, we routinely manage nondisplaced C2 fractures (odontoid, hangman's) nonoperatively with either a hard collar or a halo. [25][26][27][28][29] However, in the setting of fractures with neurological deficits or displaced fractures, we perform posterior-based decompression and stabilization.…”

Morbidity and Mortality in Patients over 90 Years of Age Following Posterior Stabilization for Acute Traumatic Odontoid Type II Fractures: A Retrospective Study with a Mean Follow-Up of Three Years

“…On the other hand, conservative treatment with a halo vest or rigid cervical collar also correlates with a high morbidity and mortality as a result of cardiac arrest, pneumonia, and pulmonary embolism [29]. Nonsurgical treatment strategies for odontoid type II fractures have recently revealed a complication rate in up to 66% and an early death rate in up to 42% [11,[30][31][32][33][34]. Furthermore, nonunion rates have been described in up to 85% due to inadequate reduction or insufficient stabilization and fracture displacement [35][36][37][38].…”