HALO IMMOBILIZATION OF CERVICAL-SPINE FRACTURES - INDICATIONS AND RESULTS

Patients (33) with a spectrum of cervical spine fractures or subluxations were treated with immobilization by a halo apparatus. All spines were assumed to be unstable because of the nature of the fracture or because of a subluxation noted on spine films. Treatment consisted of immobilization and fracture reduction followed by application of a halo plaster cast or molded halo plastic vest. Patient acceptance was high. Complications were few and minor. No patient experienced neurological deterioration during treatment. Reduction was well maintained during an average halo immobilization period of over 3 mo. Use of the halo resulted in healing of bone and ligament and restoration of stability in 85% of the patients. Halo immobilization was effective in the treatment of odontoid and hangman''s fractures and complex fractures involving multiple areas of a single vertebra. It was a successful adjunct to posterior cervical fusion. Several patients with subluxations or angulation without bone injury were treated successfully; 2 of the 4 therapy failures occurred in this group of patients. The halo must be used with caution in this clinical setting. Contraindications to the use of the halo include complete cervical spinal cord injury with anesthetic skin, tomographic and/or myelographic evidence of disc or bone within the spinal canal and unsatisfactorily reduced subluxations. The halo provided more effective and reliable immobilization than other orthoses. It is an acceptable alternative to cervical fusion for the achievement of stability in a wide variety of cervical spine fractures and dislocations avoiding the short-term and perhaps long-term complications of spinal fusion.