Halo Brace

Excerpt

The halo vest immobilizer (HVI) is a device that restrains the cranium to the torso for both adult and pediatric patients. This device provides the most rigid form of external immobilization for the upper cervical spine (occipitocervical and atlantoaxial junction). When compared to conventional cervical orthoses (CO), it is the best choice for immobilizing the upper cervical spine since it can restrict atlantoaxial joint flexion-extension by 75% versus only 45%, respectively. When applied, there is intercalated paradoxical motion (least controlled being lateral bending) within the sub-axial cervical spine (at/below C3), and therefore conventional cervical orthoses are more effective in immobilizing this region. Originally developed in 1959 by Perry and Nickel to provide cervical immobilization for occipitocervical fusion in poliomyelitis patients, this device application protocol and vest design has since evolved, allowing for a multitude of uses, including the definite treatment of upper cervical spine trauma (most common), preoperative reduction of spinal deformities, and postoperative adjuvant stabilization.

Examples for definitive treatment are occipital condyle fractures, occipitocervical dislocation, C1 (most common), and C2 fractures, with an anticipated average healing time of 3 to 4 months. When used as a definitive treatment, the success rate has been reported to be around 85%. However, this is directly affected by proper indication, application, and management of the device. The HVI does come with risks, which has made providers reluctant to use it as definitive treatment, especially in the elderly. This device can be used in the pediatric population for cervical spine trauma (definitive or conjunction with surgical management), severe scoliosis, and arthrodesis. HVI is also safe for toddlers (less than 4 years old); however, ambulation should be restricted within this age group. Pediatric and toddler populations have reduced skull thickness. Therefore there are differences in HVI application, including using a higher number of pins (8-12) onto the cranium, with a lower insertion torque force (1 to 5 inch-lb). The HVI has been shown to have successful outcomes for managing some cervical spine injuries. However, there are strict indications for its use in the pediatric and adult population, particularly the elderly.