Three-phase surgical treatment assisted with Halo-vest for special Anderson-D'Alonzo type Ⅱ and superficial type Ⅲ odontoid fractures / 中华创伤杂志

Objective To assess the efficacy of internal fixation assisted with Halo-vest in the treatment of Anderson-D'Alonzo type Ⅱ and superficial type Ⅲ odontoid fractures.Methods A retrospective case series study was made on 15 patients clinically diagnosed as Anderson-D'Alonzo type Ⅱ and type Ⅲ odontoid fractures with a fracture gap over 2 mm,displacement over 5 mm and broken end angel over 11° from January 2007 to January 2015.There were nine males and six females,aged 27-61 years [(44.5 ± 10.9)years].The patients were treated in "three phases" with the assistance of Halo-vest external fixation system and a novel guide pin aiming device.The three phases were as follows:phase Ⅰ:cervical traction reduction and halo-vest external fixation;phase Ⅱ:Halo-vest assisted internal fixation using the novel aiming device;phase Ⅲ:the Halo-vest fixation removal and cervical collar fixation.Operation duration,intraoperative bleeding,and postoperative visual analogue scale (VAS) pain score one month after the operation were recorded.The cervical lateral and open mouth X-ray or atlantoaxial CT scan with sagittal and coronal two-dimensional reconstruction were regularly reviewed,and the location of screws,reduction and fracture healing were evaluated.Results Operation duration ranged from 54 to 96 minutes [(71.3-± 11.9) min].The intraoperative blood loss was 5-60 ml [(32.6 ± 16.8) ml].There was no spinal cord or nerve root injury,cerebrospinal fluid leakage,wound infection or other complications.All patients were followed up for 12-36 months (mean,28 months).Fourteen patients were seen bony union 6 months after the surgery and one patient was seen a false joint.At the last follow-up,the patient with false joint was seen bone sclerosis,and other patients with sound bone healing.The preoperative VAS and that of one month after the operation was (7.3 ± 0.6) points and (1.6 ± 0.7) points,respectively (P ＜ 0.05).Conclusion For Anderson-D'Alonzo type Ⅱ and type Ⅲ odontoid fractures,which have a fracture gap greater than 2 mm,displacement more than 5 mm,broken end angle above 11 degrees,the three-phase Halo-vest assisted internal fixation can provide good stability before operation and promote bone healing and pain relief after operation.

Halo-vest for cervical pain in a home care patient with esophageal cancer and cervical spine metastases

Introduction：Halo-vest is usually used temporary to immobilize the cervical spine after surgery or injury. We experienced a good pain relief by halo-vest attachment in one patient with metastatic tumors of cervical spine. Case：A 76-year-old male patient was diagnosed with cervical spine metastases during chemotherapy treatment for lymph node recurrence 7 years after the first surgery for his esophageal cancer. His neck and back pain did not improve even after pain management by analgesics and radiotherapy. He also experienced strong side effects due to opioid treatment. Eventually, he became immobile. Halo-vest was applied solely for the purpose of pain control. Since then, his pain diminished, opioid stopped and his gait recovered. After moving to a hospital close to his home, he was discharged from the hospital. He could stay at home without a severe complication and opioids for 2 months. Discussion：Fixation of the cervical spine with halo-vest might be a good procedure for pain relief in patients with cervical spine metastases. However, since it could also be a stressful treatment and might cause a severe complication, thorough discussion for the use of a halo-vest is mandatory with the patient, family, and orthopedists.

Optimal Use of the Halo-Vest Orthosis for Upper Cervical Spine Injuries

PURPOSE: Upper cervical fractures can heal with conservative treatments such as halo-vest immobilization (HVI) and Minerva jackets without surgery. The most rigid of these, HVI, remains the most frequently used treatment in many centers despite its relatively high frequency of orthosis-related complications. We conducted this study to investigate the clinical outcome, effectiveness, patient satisfaction, and associated complications of HVI. MATERIALS AND METHODS: From April 1997 to December 2008, we treated 23 patients for upper cervical spinal injuries with HVI. For analysis, we divided high cervical fractures into four groups, including C1 fracture, C2 dens fracture, C2 hangman's fracture, and C1-2 associated fracture. We evaluated the clinical outcome, complications, and patient satisfaction through chart reviews and a telephone questionnaire. RESULTS: The healing rate for upper cervical fracture using HVI was 60.9%. In most cases, bony healing occurred within 16 weeks. Older patients required longer fusion time. We observed a 39.1% failure rate, and 60.9% of patients experienced complications. The most common complications were frequent pin loosening (34.8%; 8/23) and pin site infection (17.4%; 4/23). The HVI treatment failed in 66.7% of patients with pin site problems. The patient approval rate was 31.6%. CONCLUSION: The HVI produced frequent complications and low patient satisfaction. Bony fusion succeeded in 60.9% of patients. Pin site complications showed a tendency to influence the outcome of HVI, and would be promptly addressed to prevent treatment failure if they develop. The decision to use HVI requires an explanation to the patient of potential complications and constant vigilance to prevent such complications and unsatisfactory outcomes.

Clinical reseach on the treatment of traumatic cervical fracture or dislocation with Halo-vest external immobilization / 中国矫形外科杂志

[Objective] To evaluate the efficiency of Halovest external immobilization on the treatment of traumatic cervical fracture or dislocation.[Method]From February 1997 to July 2005,129 patients with cervical fracture or dislocation were treated in our hospital;all the patients were divided into two groups randomly.First group: 70 patients were treated with Halo-vest traction,among them 31 patients were treated with Halo vest combined jacket orthosis;others were treated with Halo vests and surgery(anterior route approach 18 cases,posterior route approach 17 cases,4 patients operated by anterior and posterior approach).The second group: 59 patients were treated with skull traction.Among them 13 patients were treated with skull traction and orthosis,others were treated with skull traction and surgery(anterior route approach 22 cases,posterior route approach 20 cases,4 patients operated by anterior and posterior approach).[Result]All the patients were followed 6~48 months(average 12 months).There was no statistical significance in two groups with reduction of upper cervical spine fracture and dislocation.However on the reduction of lower cervical injury groups,the prognosis with Halo-vest is significantly better than the other group.And the time for bed rest was much less than the skull traction.All the patients' spinal cord function improved obviously after treatment.[Conclusion]Halo-vest external fixation is an easy and effective way to treat cervical injuries.It can improve the reduction of the cervical injuries and it's capability of reduction and maintenance are much better than skull traction.

Unstable C1, 2 Cervical Spine Injuries Treated with Halo vest / 대한정형외과학회잡지

In a consecutive series of 15 patients with unstable C1,2 cervical spine injuries treated with halo vest, 1992-1996, a total 7 patients (comprising 46%) among the patients with C1,2 cervical spine injuries, had odontoid fractures, no patient had neurologic injury. In all cases, initial treatment was Halter or skull traction for 1-2weeks. In the vitally stable state, they were stabilized with halo vest for 12-16 weeks. In 2 cases of C1,2 instability, initial treatment was internal fixation and halo vest for the same time. 2 cases of the patients, who were treated with halo vest, had additional posterior wiring and fusion due to instability checked after removal of halo vest. There was no other serious complications during the treatment. One case (25%) of 4 Anderson-d' Alonzo type II fractures was failed to unite. The halo vest was well tolerated in all patients and assured a high percentage of healing. Flexion-extension motion was measured with dynamic lateral cervical tomography. The age range was 17-67 (mean 41.3) years and male/female ratio was 3/2. Complications during the treatment were pin loosing (1 case) and halo vest frame breakage due to falling down. Pain on motion and stiffness of neck were the most frequently remained symptoms. But the symptoms were mild and did not usually have any major impact on return to work or leisure activities.

Surgical Treatment of Instability of Upper Cervical Spine Associated with Trauma

With the aim of determining the outcome of surgery, a review of patients undergoing trauma-associated atrantoaxial arthrodesis. Between 1993 and 1997, 16 patients underwent 19 proceedures, with a follow-up period of between six and 29 months. The most common reasons for surgery were odontoid fracture(n=12), os odontoideum(n=1) procedure, and neurofibrimatosis type I(n=1). Ten posterior wiring, four Halifax clamp application, one anterior screw fixation of dens, two transarticular screw fixations, and one staged operation(anterior odontoiddectomy and posterior occipitocervical fusion) were performed. All patients has been surgically managed for about three months with a Halo-vest or rigid cervical neck collar, during which time three complications associated with operative procedures arose : Halifax clamp dislodgement, malunion and subluxation kyposis. In 15 of 16 patients, fusion was successful. In caes involving complicated atlantoaxial dislocation, the authors recommend postoperative Halo-vest immobilization for sucessful fusion after posterior C1-C2 wiring or Halifax clamping

Anterior Interbody Fusion through the Retropharyngeal Approach for Hangman's Fracture: Report of 2 Cases

Most patients with hangman's fracture frequently responded to consertvative therapy consisted of skeletal traction and halo vest, and surgery to stabilize or reduce further injury is seldom necessary. But occasionally operative stabilization may be necessary and can be achiveed satisfactorilly through anterior or posterior approach. Anterior interbody fusion at the G2-3 interspace has advantages of immediate bony stabilization with preservation of rotatory motion compared with posterior approach.

Surgical Experience of Cervical Spine Injury

Development of new surgical devices and approaches for management of injuries to the cervical spine has offered various methods of treatment available. Making it is not easy in choosing the most suitable method of treatment. We present our experience and results of 90 operations performed during the past eight-year-period(1986-1993) including 10 halo-vest applications. The timing of operation was within 7 days posttrauma in 34.2%, 8-14 days in 27.4%, 15-28 days in 1.0%, and over 28 days in 27.4%. In 18 cases of upper(C1-3) cervical spine injuries, 23 operations were performed, all approached from the posterior. In 5 cases of lower(C4-7) cervical spine injuries, 67 operations were performed, the anterior approach used in 33 patients and the posterior approach in 18 patients. Halo-vest was applied in 6 patients with upper cervical spine injuries and in 4 patients with lower cervical spine injuries. The halo-vest was inadequate in maintaining the stability of the injured spine in 5 out of 0 cases. The complication rate was 23.3% in postrior approaches and 32.4% in anterior approaches. Overall, 27 complications(0%) occurred in 90 operations, and the reoperation rate was 16.4%(85 operations for 73 patients, except for the halo-vest applications). Internal fixation with a variety of devices has become a popular procedure for ervical spine injuries. Despite the popular and wide usage of such devices, the occurrence of complications and the need to reoperate has rendered the procedure to be applied with much caution regarding its technical aspects and possible problems it may pose. In our study, the rate of reoperation and complications following such procedures were quite high. We conclude that in choosing the most proper surgical approach for ervical spine injuries with minimal occurrence of any complications, a stringent criteria should be adhered to rather then easily select the more fashionable, new of fancy devices over the traditional techniques.

Odontoid Process Fracture in a 18-Month-Old Child

A 18-month-old child admitted with neck pain, spasm and neck motion limitation after traffic accident. On C-spine lateral view, there was anterior angulation of odontoid process with anterior displacement of atlas. Neurologic examination showed no specific focal deficits. The patient was treated with Gardner-Wells tongs traction, skeletal traction with wiring, Halo vest for 2 months, Minerva cast for 2 months and cervical collar brace. Eight months after the trauma, follow-up dynamic C-spine lateral view showed bone fusion without false movement or growth retardation.