Complications of Halo Vest Orthosis

Since its introduction in 1959 by Perry and Nickel, the halo fixation device has become the most common means used to immobilize the unstable cervical spine. The majority of the reviews in the literature concerning the halo have concentrated on its ease of application, the tolerance of the device by the patient, the degree of immobilization obtained, and its success in maintaining reduction and achieving healing after a fracture or arthrodesis. Although other authors have reported complications in their patients, no prior review has concentrated specifically and concisely on the complications that may be associated with use of the halo fixation device. The purpose of this study is to evaluate the problems associated with halo orthosis.

To provide up-to-date information on complications of halo, we concisely reviewed the halo complications. Using the keyword halo vest orthosis, unstable cervical spine fracture, halo vest complications, halo vest immobilization ,pin site related complications, vest related complications all the relevant articles were retrieved from Google Scholar, Medline, PubMed, and etc. reviewed, and critically analyzed.

Halo vest was initially designed to be used after surgery on patients paralyzed by poliomyelitis, its current use is primarily related to spinal trauma or reconstructive procedures on the cervical spine.  Compared with conventional orthoses, the halo vest or halo body jacket offers more rigid immobilization of the cervical spine, the ability to more precisely position the neck to obtain or maintain cervical alignment, and less interference with mandibular motion and eating.  However, we have found the overall complication rate to be relatively high but no permanent serious sequelae from these complications reported despite the documentation of problem areas. Though rare, penetrating injuries after cranial pin insertion can occur. Halo devices must be applied by, or under close supervision of, experienced personnel to avoid such complications, and halo vests should be reviewed frequently to detect such incidents early.

Our review is the initial step in an evaluation of the halo, and it does delineate areas in need of further investigation. Loosening and infection are particularly common and imply that further basic research in halo-pin design and application is needed. To date, only changes in the superstructure of the halo have been made since its first description by Perry and Nickel in 1959.