Non-operative treatment of injuries of the upper cervical spine: our experience with a new carbon fibre halo system

Abstract

Fractures of the upper cervical spine account for about 20% of all cervical spinal injuries. Only in a minority of cases a neurological damage occurs. With exception of the type-2-dens fracture the treatment of choice is non-operatively in the halo-thoracic brace. We report about our experience with Bremer® Halo System, an open ring carbon fibre design which especially facilitates the treatment of head injured patients in bed. We treated 13 patients (m/w 9/4), mean ages 40 years (range 18–73) with 10 dens fractures Anderson and d’Alonzo-type III and 3 hangman’s fractures Effendi-type I. Five patients had additional head injury. Two of them were unconscious at the time of application of the halo-device. Our routine follow-up included roentgenograms after halo-application and 6 weeks later. After 3 months CT-scans were performed to evaluate fracture union. After 12–20 weeks the halo-device could be removed. We observed one halo ring loosening in a patient with oversize skull resulting in earlier removal in presence of an already established union. In one case we had a delayed union which eventually united in stiff collar after 6 month. No pin tract infection was observed. All patients returned to their pre-injury activities. A slightly limited rotation of the head was observed in most of the patients. The Bremer® Halo System proved to be a reliable unsophisticated halo system in the treatment of upper cervical spinal injuries. The feature of the open ring design especially facilitates the treatment of an accompanying head injury. We experienced a problem with a limited size of the halo ring.