A review of halo vest treatment of upper cervical spine injuries

Thirty-five relevant studies involving in total 682 patients with 709 diffe rent types of injuries were evaluated in a review to determine the outcomes after immobilisation II a halo vest for various injuries to the upper cerv ical spine between 1962 and 1998. Studies were analysed according to the ty pe of injury pattern and in terms of the treatment outcomes following prima ry treatment with a halo vest. The following types of injuries were evaluat ed: odontoid fractures (n = 420), hangman's fractures (n = 172), other axis fractures (n = 75), Jefferson fractures (n = 26), C1 arch fractures (n = 9 ), atlantooccipital (n = 2) and atlantoaxial dislocations (n = 5). The liga mentary atlantooccipital dislocations never healed. All isolated C1 ring fr actures healed completely; The isolated C1 arch fractures healed in 83% of the cases. The ligamentary atlantoaxial dislocations had a 60% rate of heal ing. Healing was noted in all isolated odontoid type I fractures, 85% of th e isolated odontoid type II fractures, and 67% of the odontoid type Il frac tures with combined injuries. The isolated odontoid type-III fractures had a 97% healing rate. The non-classifiable odontoid fractures had a healing r ate of 85%. The stable C2 arch fractures (hangman's fracture) healed consis tently in 99%, and 90% success was found for other C2 fractures. A halo ves t can be recommended for patients with isolated Jefferson fractures, hangma n's fractures, odontoid type III and type II fractures, with a low dislocat ion rate. The results of treatment with a halo vest were unsatisfactory wit h regard to combined injuries with an odontoid type II fracture. An overall healing rate of 86%, however, allows one to conclude that this treatment c ontinues to be a good alternative to operative stabilisation of bone injuri es to the upper cervical spine.