Optimal Use of the Halo-Vest Orthosis for Upper Cervical Spine Injuries

Shin

et al. 2011

J Korean Neurosurg Soc

Self Cite

or HVI may provide adequate support in type II fracture or type III stable fractures. Posterior fixation of C1-2 achieves higher fusion rates compared to conservative treatment, but is a challenging surgical technique and results in limitations in the cervical range of motion after surgery 5,17,18,22) . Anterior fixation techniques such as direct anterior odontoid screw fixation preserve rotatory motion of the cervical spine, with immediate stabilization of the spine 8,12,24,25) . In this study, we retrospectively analyzed preoperative and postoperative clinical and radiographic findings of patients with odontoid fractures who were treated with either nonsurgical management (HVI) or surgical fixation using the anterior or posterior approach. Efficacy and comparative treatment outcomes of these methods for odontoid type II and III fractures are also discussed. MATERIALS AND METHODSAfter we received approval from our Institutional Review Board, we retrospectively reviewed all patients with high cervical fractures treated between April 1997 and December 2008. We treated 60 patients with high cervical fractures. This study INTRODUCTIONMore than 60% of spinal injuries involve the cervical spine, and about 25% of all cervical spinal injuries affect the axis 6,7) . The most common axis injury is odontoid fracture, of which the majority are type II or type III dens fractures 3,6) . Treatment strategies for odontoid fractures are based on fracture type, the degree of initial dens displacement, the angulation of the dens with respect to the body of C2, and the age of the patient. The nonunion rate for odontoid fractures is between 4% and 64% depending on the fracture site and method of treatment 16,21,26) . Therapeutic options range from conservative treatment, including soft neck collars, rigid cervical orthosis and halo-vest immobilization (HVI), to surgical treatments including anterior screw fixation, posterior C1-2 screw fixation, or transarticular screw fixation. Non-surgical treatment with cervical collar Department of Neurosurgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, KoreaObjective : In the present study, authors retrospectively reviewed the clinical outcomes of halo-vest immobilization (HVI) versus surgical fixation in patients with odontoid fracture after either non-surgical treatment (HVI) or with surgical fixation. Methods : From April 1997 to December 2008, we treated a total of 60 patients with upper cervical spine injuries. This study included 31 (51.7%) patients (22 men, 9 women; mean age, 39.3 years) with types II and III odontoid process fractures. The average follow-up was 25.1 months. We reviewed digital radiographs and analyzed images according to type of injury and treatment outcomes, following conservative treatment with HVI and surgical management with screw fixation.Results : There were a total of 31 cases of types II and III odontoid process fractures (21 odontoid type II fractures, 10 type III fractures). Fifteen patients underwent HVI (10 type II fractures, 5 typ...

Section: Angulationmentioning

confidence: 50%

Section: Discussionmentioning

confidence: 99%

Section: Angulationmentioning

confidence: 99%

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Clinical Outcomes of Halo-Vest Immobilization and Surgical Fusion of Odontoid Fractures

Shin

et al. 2011

J Korean Neurosurg Soc

Self Cite

Curr Rev Musculoskelet Med

“…Halo ring slippage, loosening, infection, and irritation and discomfort are common [7,20]. Halo vest immobilization (HVI) failure rates reported in the literature reach as high as 85 % [23]. Pediatric patients in particular are subject to complications with use of halo vests [7].…”

Section: Management Techniques Nonoperative Managementmentioning

confidence: 99%

C1 fractures: a review of diagnoses, management options, and outcomes

Mead

Millhouse

Krystal

et al. 2016

The atlas is subject to fracture under axial load, often due to traumatic injuries such as shallow dives and automobile accidents. These fractures account for 2-13 % of injuries to the cervical spine [Marcon RM et al. Clinics (Sao Paulo) 68(11):1455-61, 2013]. Fractures of the C1 vertebra are often difficult to diagnose, as there is often no neurological deficit or easily identifiable findings on radiographs. However, injuries to the atlas can be associated with vertebral artery injury and atlantoaxial or atlanto-occipital instability, making prompt and accurate diagnosis imperative. A detailed understanding of the anatomy, inherent stability, and common injury patterns is essential for any surgeon treating spinal trauma. This chapter explores the diagnosis and management of C1 fractures, as well as outcomes after treatment.

“…We previously studied halo vest immobilization treatment for upper cervical spine in- juries, including hangman's fractures. 20 Unfortunately, the procedure showed many disadvantages, such as impaired neurological function, fusion failure, and persistent neck pain due to pseudarthrosis. Also, pin-related problems, such as cerebral skull fracture, hematoma formation, skin breakdown, and pin-site infection, exist.…”

mentioning

confidence: 99%

Primary surgical management by reduction and fixation of unstable hangman's fractures with discoligamentous instability or combined fractures

Shin

Cho

et al. 2013

SPI

Self Cite

Object Several controversial issues arise in the management of unstable hangman's fractures. Some surgeons perform external reduction and immobilize the patient's neck in a halo vest, while others perform surgical reduction and internal fixation. The nonsurgical treatments with rigid collar or halo vest immobilization present problems, including nonunion, pseudarthrosis, skull fracture, and scalp laceration and may also fail to achieve anatomical realignment of the local C2–3 kyphosis. With recent advances in surgical technique and technology, surgical intervention is increasingly performed as the primary treatment in high cervical fractures. The outcomes of such surgeries are often superior to those of conservative treatment. The authors propose that surgical intervention as a primary management for hangman's fracture may avoid risks inherent in conservative management when severe circumferential discoligamentous instability is present and may reduce the risk of catastrophic results at the fracture site. The purposes of this study were to assess fracture healing following expedient reduction and surgical fixation and to propose a guideline for treatment of unstable hangman's fractures. Methods From April 2006 to December 2011, the authors treated 105 patients with high cervical fractures. This study included 23 (21.9%) of these patients (15 men and 8 women; mean age 46.4 years) with Type II, IIa, and III hangman's fractures according to the Levine and Edwards classification. The patient's age, sex, mechanism of injury, associated injuries, neurological status, and complications were ascertained. The authors retrospectively assessed the clinical outcome (Neck Disability Index), radiological findings (disc height, translation, and angulation), and bony healing. Results The average follow-up period was 28.9 months (range 12–63.2 months). The overall average Neck Disability Index score at the time of this study was 6.6 ± 2.3. The average duration of hospitalization was 20.3 days, and fusion was achieved in all cases by 14.8 ± 1.6 weeks after surgery, as demonstrated on dynamic radiographs and cervical 3D CT scans. The mean pretreatment translation was 6.9 ± 3.2 mm, and the mean postoperative translation was 1.6 ± 1.8 mm (mean reduction 5.2 ± 3.1 mm). The initial angulation was 4.7° ± 5.3° and the postoperative angulation was 2.5° ± 1.8° (mean reduction 6.1° ± 5.3°). The preoperative and postoperative values for translation and angulation differed significantly (p < 0.05). The overall C2–3 disc height was 6.7 ± 1.2 mm preoperatively, whereas 3 months after surgery it was 6.4 ± 1.1 mm. These values did not differ significantly (p = 0.0963). Conclusions The authors observed effective reduction and bony healing in cases of unstable hangman's fractures after fixation, and all patients experienced favorable clinical outcomes with neck pain improvement. The protocols allowed for physiological reconstruction of the fractured deformities and avoided external fixation. The authors suggest that posterior reduction and screw fixation should be used as a primary treatment to promote stability of hangman's fracture in the presence of discoligamentous instability or combined fractures.