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Thursday, March 1, 2001

Study evaluates use of pinless halo in children

A halo vest with pins in the skull is the gold standard for providing maximum immobilization and control of the cervical spine, say researchers who evaluate the use of a noninvasive halo in poster exhibit 133.

They note inherent complications of a halo vest including scarring, infection, cerebrospinal fluid leakage, pin loosening, and penetration of the cranial vault. Other less invasive orthoses provide significantly less immobilization and control of the cervical spine.

A pinless halo has been developed with the goal of providing cervical spine immobilization and control similar to the standard halo in a less invasive fashion. This non-invasive halo holds the head with pads on the forehead and occiput, and is connected through a universal joint to an adjustable vest.

The pinless halo was used on 11 children ages 2 to 15 years for the following indications: congenital muscular torticollis release, C1-C2 rotatory subluxation reduction and postoperative immobilization, cervical fusion immobilization, tumor removal, and odontoid fracture.

The pinless halo provided uncomplicated cervical spine immobilization in 8 of 11 patients. In the two youngest children, both age 2, there was facial swelling and intolerance of the pads against the face. Both children were changed to a standard halo without complication. One failure was attributed to family non-compliance leading to placement of a standard halo.

In its present form the investigators do not recommend the pinless halo for small children as this was poorly tolerated in the youngest children, both age 2. They said this device was particularly useful in the gentle and safe reduction of longstanding C1-C2 rotatory subluxations and for postoperative immobilization in an overcorrected position following sternoclidomastoid release for congenital muscular torticollis.

Coauthors are David L. Skaggs, MD; Vernon T. Tolo, MD, and Mark Grippi, MD, of Childrens Hospital of Los Angeles, Calif.; and Max Lerman, BSCO, and Lawrence Lerman, BSCO, orthotists in private practice in Los Angeles, Calif.

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2001 Academy News March 1 Index B

Last modified 20/February/2001 by IS