HALO VEST IMMOBILIZATION: IS IT STILL A VALID TREATMENT FOR THE ATLANTO-AXIAL FRACTURES?

Abstract

IntroductionAtlanto-axial injuries pose a significant threat to morbidity and mortality. This retrospective study aims to analyze clinical and radiological results, failure rates, and complications in a series of patients treated with a halo vest, validating the effectiveness of this device through long-term follow-up. Materials and methodsThis study reviewed adult patients with acute upper cervical spine injuries treated with halo vest immobilization from 1994 to 2022. Fracture types were classified based on Computed Tomography (CT) characteristics. Clinical and radiological follow-ups were performed at the end of treatment and at 3 months after the removal of the system. ResultsMost treated patients were males (70%) with a mean age of 38 years. Car accidents were the primary cause of injury (63%). Among 161 patients, 134 had a C2 fracture, 20 had a C1 fracture, 5 had a C1-C2 rotational dislocation, and 2 had other unclassified combined C1/C2 fractures. Patients without additional injuries or neurological deficits had significantly shorter hospitalization (8 vs. 16 days and 12 vs. 22 days, respectively) compared to those with additional injuries (p value<.00001) or neurological deficits (p value=0.00164). At the 6-month follow-up, radiological and clinical outcomes were available for 147 patients. X-rays in 139 cases showed fracture fusion (94.6%). Clinical follow-up revealed normal or slightly reduced range of motion in 144 cases (98%). Pain was absent or episodic in all the patients except one. In 131 cases (89%), an excellent or good clinical result was achieved. Complications did not impact treatment. ConclusionsBased on our results, the halo vest is a valid treatment for atlanto-axial injuries in selected patients. This includes young and middle-aged individuals (up to 65 years old) with C1 and/or C2 fractures. Halo vest treatment is associated with minor complications and yields a high percentage of excellent/good clinical results.