Abstract :
Background: Many cervical spine injuries can be treated without surgery. Immobilization in a rigid cervical orthosis for 8 to 12 weeks may be sufficient. Objective : To evaluate the results of management of unstable upper cervical spinal injuries by halo vest orthosis for 12 weeks . Methods and Results: During last three years, thirty patients had upper cervical injury, age ranged between 9 to 65 years. Twenty-six of them were male and only four were female, occipito-atlantal subluxation in one patient, odontoid fractures type II in four and type III in three patients, Jefferson fracture in seven patients, Hangman s fracture type I in four and type II in seven patients, and multiple fracture of CI and C2 in four patients. Road traffic accident was the common cause (in twenty-eight pat) and falling from a height in two patients. In two patients cardiac arrest and/or unexplained disturbance of pulse and blood pressure in traumatic patients was the clue to do further investigations to diagnose the upper cervical injury particularly with normal findings of conventional plain X-Ray. Spiral CT Scan and MRI were essential for proper diagnosis of unstable upper cervical injury. Halo vest was appled for all patients immediately after the proper diagnosis except one patient applied after failure of surgical fusion due to break of C1, C2 wire. Immobilization in halo vest continued for three months . X-ray was done immediately after application of halo vest to assess the alignment and then was done after one week, 3 weeks ; 8 weeks and later 12 weeks before removal of the halo. Two patients developed cardiac arrest before and after halo vest application, they needs surgical fixation. One patient had multiple spinal fracture due to falling from a height ( Fracture C1, C2 and fracture dislocation of D9, D10 ) He had complete paraplegia. Other patients neurologically intact .After 3 months halo vest was removed and assess the stability by dynamic films , twenty-five patients achieved accepted alignment and stability. Resubluxation (1/30) in an adult with type-II odontoid fracture and was operated by posterior CI-2 wiring. Local osteomylitis (2/30) improved after removal of the halo. Anxiety (4/30). Follow-up period 6-36 months (average 22 months). One patient showed no improvement ( still quadriplegic and ventilator dependent ) , The patient of multiple spinal injury showed partial recovery . Conclusion : Halovest fixation is a safe and effective method of treatment for upper cervical spinal fractures in adults. Halo use has been credited with enabling earlier ambulation of the patients with severe cervical instability , thereby allowing a more rapid entry into rehabilitation and decreasing secondary complications of immobility. Surgical fixation should be reserved for ligamentous injuries, non-union fractures, and intolerating of halovest.
