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Spine

Application of Halo

Aims

  • Aim for non-operative stabilisation of cervical spine fracture / dislocation
  • May also be used as supplemental support after operative stabilisation / fusion/ decompression
  • Advantage is adjustability
  • Alternative is surgical stabilisation or less stable orthoses (eg Philadelphia, Minerva)

Indications

  • Stable C-spine fracture with no neural compression (compression Fracture, laminae, lateral mass, spinous process)
  • Reduced unilateral facet dislocations
  • Supplemental support post-op

Principles

Stability

  • Limit flex/ext to 4%, lateral flex to 4%, rotation to 1% but may see 3 degree or 3mm fracture site motion due to “snaking” mechanism between erect / supine

Position

  • Supine, head off end of bed, supported by assistant or device under chest

Procedure

  • Plan pin sites
    • appropriate size halo (5/8)
    • centre hole over bridge of nose
    • 1 cm above tips of ears, eyebrow level (below greatest diameter)
    • 2 ant-lateral pins > lateral 2/3 of orbit
    • 2 post-lateral pins > behind ears (above mastoid)
  • Shave, prep, local/adrenaline
  • Incision / screw pins
  • Tighten 2 diag opposite pins simultaneously
  • Close eyes to prevent skin tethering for anterior pins
  • Engage pins through skin & bone with torque screwdriver (maintain ring symmetrical)
  • 8 inch-pounds of torque
  • Attach pins to halo with lock nuts, then halo to vest
  • Re-tension next day
  • AP / Lat Xray C-spine

Complications / Dangers

Perioperative

  • Pin loosening (re-tighten once)
  • Pin infection (pin care)
  • Pin site pain
  • Pressure sores under vest
  • Scars
  • Nerve injury (supraorbital, supratrochlear) (avoid medial 1/3 orbit)
  • Temporalis tether/ bleeding (go anterior)
  • Dysphagia
  • Dural puncture
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