Objective: Installation of an external fixator in combination with a body cast for temporary or definitive immobilization and retention of unstable fractures of the craniocervical junction and upper part of the cervical spine. Further established applications include presurgical extension treatment of paralytic scoliosis and temporary retention within complex spine deformity operations after ventral release or mobilized osteotomies.
Indications: Closed reposition and temporary retention of unstable injuries of the cervical spine up to operation. Extension treatment for careful reposition of fresh or dated malpositions of the cervical spine. Conservative treatment of injuries of the craniocervical junction and the upper part of the cervical spine. Presurgical extension of paralytic scoliosis. Temporary extension after ventral release.
Contraindications: Cranial fractures and intracranial injuries. Soft-tissue infections of the skull. Children < 3 years. Adiposity, chest injuries and paraplegia as relative contraindications using the halo body cast.
Surgical technique: Halo traction is applied in two stages; first, the head ring is attached to the skull, then, the body cast and suspension assembly are added. Local anesthesia, depending on circumstances. Sizing of the components; the optimal size of the ring is about 1.5" larger than the circumference of the patient's head. Patient in sitting or supine position. The halo ring is held in proper position by stabilizer plates; the lower margin of the ring should be just above the ears and about 0.4" above the eyebrows. The anterior pins are placed in shallow groove on the forehead between supraorbital ridges and frontal protuberances. Threaded skull pins are screwed with defined torque (4-8"/pounds) in the lamina externa of the cranial calotte without perforating the lamina interna. To avoid side-to-side drifting, the diagonally opposite pins should be tightened simultaneously. Finally, connection of the halo ring with a body cast or putting on an extension device.
Results: Secure external stabilization of unstable injuries of upper cervical spine. Improvement of correction results of patients with neuromuscular scoliosis who underwent surgical treatment. Disadvantages are procedure-specific complications (infection and loosening of head pins) with different published frequencies and decreased patient's acceptance at longer therapy duration.