Procedure 2 Halo Placement in the Pediatric and Adult Patient
Indications
Odontoid fracture: type III or specific type II
One-column bony cervical spine fracture
Fracture in ankylosing spondylitis
Preoperative traction or stabilization
Postoperative stabilization of arthrodesis, infection, tumor resection
Treatment Options
• Consider rigid collar immobilization in a compliant, young, healthy patient with a minimally displaced, stable fracture.
• Consider surgical intervention in an elderly or noncompliant patient with an unstable or displaced fracture, a fracture of high nonunion potential, ligamentous injury, or associated injury.
• Move to surgical intervention for failure of halo fixation: loss of fracture alignment, symptomatic nonunion, neurologic deterioration.
Examination/Imaging
Computed tomography (CT) is required to define fracture morphology and stability and rule out adjacent or noncontiguous injuries (Como et al, 2009) (Figure 2-1, A–C).
Radiographs confirm fracture reduction and cervical alignment following halo application, and maintenance of these parameters during treatment (Figure 2-2).
Surgical Anatomy
Relevant anatomy pertains to pin placement. Correct placement prevents direct neural or vascular injury, inner calvarial plate penetration, and pin migration, while providing adequate strength of fixation.
