Pinless Halo in the Pediatric Population

Bakhshi, Hooman; Kushare, Indranil; Banskota, Bibek; Nelson, Christopher G.; Dormans, John P.

doi:10.1097/bpo.0000000000000267

Cited by 11 publications

(19 citation statements)

References 23 publications

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“…While most halo complications involve pin site loosening or infection, the use of pinless halos also has significant complication rates. Bakshi et al 14 reported a 21% complication rate using a pinless halo in the pediatric population. Other rare complications of halo use have been reported.…”

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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“…We identified seven publications presenting conservative treatment with HF in patients with traumatic AARS. The results and success rates are presented in Table 2 [ 6 , 11 , 17 , 29 , 35 , 44 , 50 ].…”

Section: Resultsmentioning

confidence: 99%

Use of halo fixation therapy for traumatic cranio-cervical instability in children: a systematic review

Banat

Vychopen

Wach

et al. 2021

Eur J Trauma Emerg Surg

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Purpose Traumatic cranio-cervical instability in childhood is rare and constitutes a challenge for the treating surgeon. The aim of therapy is to restore cervical stability without limiting the range of motion. The goal of this systematic review was to find out whether, over the last 10 years, halo fixation (HF) could still be considered a successful treatment option without major risks or complications. Methods We analyzed studies describing the use of HF in traumatic injuries of the cranio-cervical junction in children under the age of 17. Searches were performed in PubMed, MEDLINE and Embase databases for the years from 2010 to 2020. The general success rate, the success rate related to underlying pathologies, and complication rates were evaluated. Results The main indications for HF range from pre-surgical correction to postoperative fusion support. C2 is the most frequently injured vertebra in children. The overall success rate of HF was very high. Evaluation according to the underlying pathology showed that, except for atlanto-occipital dislocation, HF generates high fusion rates among different patient cohorts, mainly in C2 vertebra injuries and atlantoaxial rotatory subluxation. Only minor complications were reported, such as pin infections. Conclusion The current data show that, when used according to the appropriate indication, HF is an effective conservative treatment option for cranio-cervical instability, associated with only minor complications.

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“…The conventional halo can be associated with significant adverse events: infection, pin loosening, dysphagia, dural/ skull penetration, and pressure ulcers. [ 5 ] A pinless halo avoids many of these problems at the perceived expense of the stability which the pins ensure. Indeed, noninvasive halos are applied widely in pediatric neurosurgery for immobilization in situations such as congenital muscular torticollis, conservative management of nontraumatic atlantoaxial rotary subluxation, post cervical fusion surgery, and stable occipital condyle fractures.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, noninvasive halos are applied widely in pediatric neurosurgery for immobilization in situations such as congenital muscular torticollis, conservative management of nontraumatic atlantoaxial rotary subluxation, post cervical fusion surgery, and stable occipital condyle fractures. [ 5 ] Pinless halo use can lead to occipital pressure ulcers and skin infection. Our patient had an occipital laceration from the original trauma and this developed into a pressure ulcer, which needed debridement and a course of antibiotics.…”

Section: Discussionmentioning

confidence: 99%

Management of traumatic atlanto-occipital dislocation in a 10-year-old with noninvasive halo immobilization: A case report

Shekhar

Mancuso-Marcello

Emelifeonwu

et al. 2022

Surgical Neurology International

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Background: Traumatic atlanto-occipital dislocation is an unstable injury of the craniocervical junction. For pediatric patients, surgical arthrodesis of the occipitocervical junction is the recommended management. While having a high success rate for stabilization, the fusion comes with obvious morbidity of limitation in cervical spine flexion, extension, and rotation. An alternative is external immobilization with a conventional halo. Case Description: We describe the case of a 10-year-old boy who was treated successfully for traumatic AOD with a noninvasive pinless halo. Following initial brain trauma management, we immobilized the craniocervical junction with a pinless halo after reducing the atlanto-occipital dislocation. The pinless halo was kept on at all times for the next 3 months. The craniocervical junction alignment was monitored with weekly cervical spine X-rays and CT craniocervical junction on day 15th, day 30th, and day 70th. A follow-up MRI C-spine 3 months from presentation confirmed resolution of the soft-tissue injury and the pinless halo was removed. Dynamic cervical spine X-rays revealed satisfactory alignment in both flexion and extension views. The patient has been followed up for 2 years postinjury and no issues were identified. Conclusion: Noninvasive pinless halo is a potential treatment option for traumatic pediatric atlanto-occipital dislocation. This should be considered bearing in mind multiple factors including age and weight of the patient, severity of the atlanto-occipital dislocation (Grade I vs. Grade II and incomplete vs. complete), concomitant skull and scalp injury, and patient’s ability to tolerate the halo. It is vital to emphasize that this necessitates close clinicoradiological monitoring.

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Pinless Halo in the Pediatric Population

Abstract: Level IV-Case series.

Cited by 11 publications

References 23 publications

Outcomes of Halo Immobilization for Cervical Spine Fractures

Outcomes of Halo Immobilization for Cervical Spine Fractures

Use of halo fixation therapy for traumatic cranio-cervical instability in children: a systematic review

Management of traumatic atlanto-occipital dislocation in a 10-year-old with noninvasive halo immobilization: A case report

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