Acute stabilization of the cervical spine by halo/vest application facilitates evaluation and treatment of multiple trauma patients.
The management of acute cervical spine injuries has traditionally used bed-based skeletal traction until all non-neurologic injuries have been evaluated. This treatment method substantially hinders the ability to transport patients and to perform imaging studies and surgical procedures. In contrast, early application of a halo/vest apparatus provides immediate cervical stabilization and facilitates the diagnostic work-up and treatment of the patients with multiple injuries. The records of all 78 patients admitted from February 1988 through June 1991 who had acute cervical spine fractures, subluxations, or both with a risk of instability were reviewed. All patients were treated with halo/vests and no patient deteriorated neurologically following halo/vest application. Twenty-nine patients (37%) had a total of 55 associated injuries including long bone/pelvic fractures in 17, thoracic injuries in 13, closed head injuries in 11, facial fractures in 6, noncontiguous spinal fractures in 5, and abdominal injuries in 3. The mean injury Severity Score (ISS) was 18 (range, 9-54). While in the halo/vest, 43 patients (55%) had a total of 99 diagnostic studies completed and 46 patients (59%) had a total of 76 surgical procedures performed. There were 35 neurosurgical procedures on 32 patients and 41 non-neurosurgical surgical procedures on 24 patients. Over the past year, 20 of 21 patients (95%) had their halo/vest placed in the emergency department. The data demonstrate that many diagnostic and surgical procedures need to be performed on patients with unstable cervical spine injuries.(ABSTRACT TRUNCATED AT 250 WORDS)
Heary
R F
RF
Department of Surgery, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark 07103.
Hunt
C D
CD
Krieger
A J
AJ
Antonio
C
C
Livingston
D H
DH
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001915:Braces / Q000592:standards*; D002574:Cervical Vertebrae / Q000293:injuries*; D002648:Child; D002675:Child, Preschool; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D004204:Joint Dislocations / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D009515:New Jersey / Q000453:epidemiology; D016103:Spinal Fractures / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D013997:Time Factors; D014187:Transportation of Patients; D014193:Trauma Centers