Overtightening of halo pins resulting in intracranial penetration, pneumocephalus, and epileptic seizure

Glover, Alexander W.; Zakaria, Rasheed; May, Paul; Barrett, Chris

doi:10.1016/j.ijsp.2013.01.004

Cited by 15 publications

(6 citation statements)

References 12 publications

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“…Overtightening of halo pins may cause intracranial penetration, pneumocephalus, and epileptic seizure. 15,16 Intracranial abscess has also been reported. 17 Our study noted 3 patients with thoracic skin ulcers and 2 with severe prolonged swallowing problems after halo application (Table 6).…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Halo Immobilization for Cervical Spine Fractures

Isidro

Molinari

Ikpeze

et al. 2019

Global Spine Journal

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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.

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Section: Discussionmentioning

confidence: 99%

Outcomes of Halo Immobilization for Cervical Spine Fractures

Isidro

Molinari

Ikpeze

et al. 2019

Global Spine Journal

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“…The complications associated with its use have been well described in the literature. [ 11 12 13 14 15 16 ] Particularly in the elderly, its use is associated with increased incidence of pneumonia and increased mortality. [ 4 17 18 ] More recent reports have challenged this,[ 3 16 19 ] but it remains a concern for the clinician.…”

Section: Discussionmentioning

confidence: 99%

Temporary spanning internal fixation for management of complex upper cervical spine fractures

Alsaleh

Abulras

Alrehaili

2021

Journal of Craniovertebral Junction and Spine

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Introduction: Fractures of the upper cervical spine are often but not always amenable to either internal fixation or conservative management using a rigid cervical collar. For all other fractures in this area, management with a halo-vest orthosis is indicated, but it also has limitations. Here, we present an operative alternative to the halo-vest orthosis that provides more secure stability and less complications. Methods: Three patients presented to our hospital with atypical fractures of C1 and C2 and were given the choice of either a halo-vest orthosis or secure internal fixation without fusion and accepted the latter. Internal fixation without fusion from occiput to the subaxial spine was performed for all three and then removed-6 months later -after radiologic confirmation of healing. Results: All three patients underwent the procedure successfully and achieved and maintained acceptable alignment. Range of motion was preserved, and no intermediate-term issues were observed. Conclusion: Spanning internal fixation provides a safe and effective technique in the management of complex upper cervical spine injuries without the drawbacks of using a halo-vest orthosis.

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“…Facial scarring at the site of pin insertion is another distressing problem. Glover et al reported penetrative skull and dural injuries, epilepsy, and pneumocephalus due to the overtightening of the halo pins by the patient (13). Therefore, CH usage needs proper patient education and close monitoring.…”

Section: Discussionmentioning

confidence: 99%

The effectiveness and clinical outcomes of the Minerva cervical thoracicjacket in patients with type II odontoid fractures

Öztürk¹,

Erol²,

Akgun³

et al. 2017

Turk J Med Sci

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Background/aim: The objective of this study was to carry out a detailed analysis and assess the outcomes for the Minerva cervical thoracic jacket (CTJ) in patients with type II odontoid fractures who could not be surgically treated.Materials and methods: Twenty-six patients for whom the Minerva CTJ was used rather than surgery for different reasons were included in the study. All patients were fitted with the Minerva CTJ within the first 24 h following diagnosis. The patients were followed 4 weeks after hospital discharge and then at 2-week intervals. Results were considered significant at P < 0.05 and a 95% confidence interval was calculated.Results: Of the 26 patients, 17 were male and 9 were female. The mean age was 49.03 years old (range: 16-86 years old). Fusion occurred in 25 of the 26 patients (P = 0.004), and the mean time to fusion was 6.8 weeks (P = 0.002). The mean length of hospital stay was 4 days and the mean follow-up period was 7.3 weeks. None of the patients had any complications due to the Minerva CTJ and the mortality rate was 0%. Conclusions:The Minerva CTJ application was a safe and cheap technique in the management of type II odontoid fractures. It had a high fusion rate and no complications.

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Overtightening of halo pins resulting in intracranial penetration, pneumocephalus, and epileptic seizure

Cited by 15 publications

References 12 publications

Outcomes of Halo Immobilization for Cervical Spine Fractures

Outcomes of Halo Immobilization for Cervical Spine Fractures

Temporary spanning internal fixation for management of complex upper cervical spine fractures

The effectiveness and clinical outcomes of the Minerva cervical thoracicjacket in patients with type II odontoid fractures

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