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Optimal use of the halo-vest orthosis for upper cervical spine injuries.

Shin JJ, Kim SJ, Kim TH, Shin HS, Hwang YS, Park SK - Yonsei Med. J. (2010)

Bottom Line: We conducted this study to investigate the clinical outcome, effectiveness, patient satisfaction, and associated complications of HVI.Pin site complications showed a tendency to influence the outcome of HVI, and would be promptly addressed to prevent treatment failure if they develop.The decision to use HVI requires an explanation to the patient of potential complications and constant vigilance to prevent such complications and unsatisfactory outcomes.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Sanggye Paik Hospital, Inje University College of Medicine, 761-1 Sanggye 7-dong, Nowon-gu, Seoul 139-707, Korea. zunzae@hanmail.net

ABSTRACT

Purpose: Upper cervical fractures can heal with conservative treatments such as halo-vest immobilization (HVI) and Minerva jackets without surgery. The most rigid of these, HVI, remains the most frequently used treatment in many centers despite its relatively high frequency of orthosis-related complications. We conducted this study to investigate the clinical outcome, effectiveness, patient satisfaction, and associated complications of HVI.

Materials and methods: From April 1997 to December 2008, we treated 23 patients for upper cervical spinal injuries with HVI. For analysis, we divided high cervical fractures into four groups, including C1 fracture, C2 dens fracture, C2 hangman's fracture, and C1-2 associated fracture. We evaluated the clinical outcome, complications, and patient satisfaction through chart reviews and a telephone questionnaire.

Results: The healing rate for upper cervical fracture using HVI was 60.9%. In most cases, bony healing occurred within 16 weeks. Older patients required longer fusion time. We observed a 39.1% failure rate, and 60.9% of patients experienced complications. The most common complications were frequent pin loosening (34.8%; 8/23) and pin site infection (17.4%; 4/23). The HVI treatment failed in 66.7% of patients with pin site problems. The patient approval rate was 31.6%.

Conclusion: The HVI produced frequent complications and low patient satisfaction. Bony fusion succeeded in 60.9% of patients. Pin site complications showed a tendency to influence the outcome of HVI, and would be promptly addressed to prevent treatment failure if they develop. The decision to use HVI requires an explanation to the patient of potential complications and constant vigilance to prevent such complications and unsatisfactory outcomes.

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A 49-year-old man had severe neck pain after a vehicle collision, and had been previously treated with HVI. (A) The neck pain persisted for 12 weeks while HVI was applied. The lateral plain radiograph showed anterior displacement above the subaxial spine at C2 and an unhealed bony fracture. The axial CT image also showed the bony fractured particles yet unhealed. (B) A posterior fixation was performed at C1-2-3. An axial CT image shows bony healing at 12 weeks after surgery.
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Figure 3: A 49-year-old man had severe neck pain after a vehicle collision, and had been previously treated with HVI. (A) The neck pain persisted for 12 weeks while HVI was applied. The lateral plain radiograph showed anterior displacement above the subaxial spine at C2 and an unhealed bony fracture. The axial CT image also showed the bony fractured particles yet unhealed. (B) A posterior fixation was performed at C1-2-3. An axial CT image shows bony healing at 12 weeks after surgery.

Mentions: The halo-vest immobilization lasted for a mean period of 14 ± 5.9 weeks (range 1.7 to 21.9 weeks). The mean time of follow-up was 48.5 weeks (range 13.9 to 369.1 weeks). Of the 23 patients with cervical fractures, 14 (60.9%) were healed, within a mean time of 15.2 weeks (range 7.2 to 21.7 weeks). Of these, 9 patients (64.3%) achieved healing within 16 weeks. After that time, the fusion curve leveled off. The time required for fusion increased with age (Fig. 1). The initial ASIA spinal cord injury grade was distributed as follows: 1 ASIA C, 4 ASIA D, and 18 ASIA E. Among five patients with neurological deficits (three spinal cord contusion and two central cord syndrome), three became neurologically intact after halo-vest immobilization and the other two improved markedly but with residual deficit such as 2 ASIA D and 21 ASIA E. No neurological deterioration occurred with the HVI treatment. We observed failures in 9 (39.1%) of the 23 patients treated with the halo-vest immobilization (Fig. 2). These included 5 patients with C2 odontoid fractures (2 type II A, 1 type II B and 1 type II C), 2 with C1 fractures, one with a C2 hangman's fracture (type III), and one C1-2 associated fracture. Seven patients experienced continued neck pain while treated with HVI (Fig. 3). We unavoidably abandoned the HVI for other treatments in 2 patients. One of these developed an abscess and one experienced frequent pin dislodgement and a psychological problem. Of the 9 patients with failure, 3 underwent surgery (one anterior odontoid fixation, another posterior C1-2 screw fixation, and the third transarticular screw fixation), but the other 6 refused it. The six patients who refused surgery underwent conservative therapy using neck braces.


Optimal use of the halo-vest orthosis for upper cervical spine injuries.

Shin JJ, Kim SJ, Kim TH, Shin HS, Hwang YS, Park SK - Yonsei Med. J. (2010)

A 49-year-old man had severe neck pain after a vehicle collision, and had been previously treated with HVI. (A) The neck pain persisted for 12 weeks while HVI was applied. The lateral plain radiograph showed anterior displacement above the subaxial spine at C2 and an unhealed bony fracture. The axial CT image also showed the bony fractured particles yet unhealed. (B) A posterior fixation was performed at C1-2-3. An axial CT image shows bony healing at 12 weeks after surgery.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2908866&req=5

Figure 3: A 49-year-old man had severe neck pain after a vehicle collision, and had been previously treated with HVI. (A) The neck pain persisted for 12 weeks while HVI was applied. The lateral plain radiograph showed anterior displacement above the subaxial spine at C2 and an unhealed bony fracture. The axial CT image also showed the bony fractured particles yet unhealed. (B) A posterior fixation was performed at C1-2-3. An axial CT image shows bony healing at 12 weeks after surgery.
Mentions: The halo-vest immobilization lasted for a mean period of 14 ± 5.9 weeks (range 1.7 to 21.9 weeks). The mean time of follow-up was 48.5 weeks (range 13.9 to 369.1 weeks). Of the 23 patients with cervical fractures, 14 (60.9%) were healed, within a mean time of 15.2 weeks (range 7.2 to 21.7 weeks). Of these, 9 patients (64.3%) achieved healing within 16 weeks. After that time, the fusion curve leveled off. The time required for fusion increased with age (Fig. 1). The initial ASIA spinal cord injury grade was distributed as follows: 1 ASIA C, 4 ASIA D, and 18 ASIA E. Among five patients with neurological deficits (three spinal cord contusion and two central cord syndrome), three became neurologically intact after halo-vest immobilization and the other two improved markedly but with residual deficit such as 2 ASIA D and 21 ASIA E. No neurological deterioration occurred with the HVI treatment. We observed failures in 9 (39.1%) of the 23 patients treated with the halo-vest immobilization (Fig. 2). These included 5 patients with C2 odontoid fractures (2 type II A, 1 type II B and 1 type II C), 2 with C1 fractures, one with a C2 hangman's fracture (type III), and one C1-2 associated fracture. Seven patients experienced continued neck pain while treated with HVI (Fig. 3). We unavoidably abandoned the HVI for other treatments in 2 patients. One of these developed an abscess and one experienced frequent pin dislodgement and a psychological problem. Of the 9 patients with failure, 3 underwent surgery (one anterior odontoid fixation, another posterior C1-2 screw fixation, and the third transarticular screw fixation), but the other 6 refused it. The six patients who refused surgery underwent conservative therapy using neck braces.

Bottom Line: We conducted this study to investigate the clinical outcome, effectiveness, patient satisfaction, and associated complications of HVI.Pin site complications showed a tendency to influence the outcome of HVI, and would be promptly addressed to prevent treatment failure if they develop.The decision to use HVI requires an explanation to the patient of potential complications and constant vigilance to prevent such complications and unsatisfactory outcomes.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Sanggye Paik Hospital, Inje University College of Medicine, 761-1 Sanggye 7-dong, Nowon-gu, Seoul 139-707, Korea. zunzae@hanmail.net

ABSTRACT

Purpose: Upper cervical fractures can heal with conservative treatments such as halo-vest immobilization (HVI) and Minerva jackets without surgery. The most rigid of these, HVI, remains the most frequently used treatment in many centers despite its relatively high frequency of orthosis-related complications. We conducted this study to investigate the clinical outcome, effectiveness, patient satisfaction, and associated complications of HVI.

Materials and methods: From April 1997 to December 2008, we treated 23 patients for upper cervical spinal injuries with HVI. For analysis, we divided high cervical fractures into four groups, including C1 fracture, C2 dens fracture, C2 hangman's fracture, and C1-2 associated fracture. We evaluated the clinical outcome, complications, and patient satisfaction through chart reviews and a telephone questionnaire.

Results: The healing rate for upper cervical fracture using HVI was 60.9%. In most cases, bony healing occurred within 16 weeks. Older patients required longer fusion time. We observed a 39.1% failure rate, and 60.9% of patients experienced complications. The most common complications were frequent pin loosening (34.8%; 8/23) and pin site infection (17.4%; 4/23). The HVI treatment failed in 66.7% of patients with pin site problems. The patient approval rate was 31.6%.

Conclusion: The HVI produced frequent complications and low patient satisfaction. Bony fusion succeeded in 60.9% of patients. Pin site complications showed a tendency to influence the outcome of HVI, and would be promptly addressed to prevent treatment failure if they develop. The decision to use HVI requires an explanation to the patient of potential complications and constant vigilance to prevent such complications and unsatisfactory outcomes.

Show MeSH
Related in: MedlinePlus