Halo traction in basilar invagination: technical case report.
BACKGROUND
In the management of basilar invagination, traction therapy may help by pulling down the odontoid process away from the brain stem that may result in clinical and radiological improvement. We aimed to discuss the role of the halo vest apparatus traction on the reduction of severe anterior compression pathologies in basilar invagination.


METHODS
We describe a simple and safe cervical traction method by the halo vest apparatus that is followed by rigid posterior occipitocervical fixation and foramen magnum decompression in a patient who presented with basilar invagination and symptoms of severe brain stem compression. An MR-suitable halo vest apparatus was used for reduction of the deformity. The reduction of the basilar invagination was achieved gradually by distracting the halo crown in stages.


CONCLUSIONS
The halo vest apparatus can be safely used in complex craniocervical junction anomalies. An effective cervical traction can be performed in basilar invagination, and reduction of the deformity may be achieved without the risk of overdistraction. In some cases, even partial reduction of the deformity may facilitate brain stem and spinal cord relief without any need of posterior decompression. Patients may benefit from ambulatory functions because bed rest is eliminated in this procedure. Neurovascular structures and the degree of the reduction can be observed on MRIs when an MR-suitable device is used.
Simsek
Serkan
S
Neurosurgery Department, Ministry of Health, Diskapi Educational and Research Hospital, Ankara 06110, Turkey.
Yigitkanli
Kazim
K
Belen
Deniz
D
Bavbek
Murad
M
D001268:Atlanto-Axial Joint / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery; D001368:Axis, Cervical Vertebra / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery*; D020526:Brain Stem Infarctions / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D001270:Cervical Atlas / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery*; D019299:Decompression, Surgical / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D016267:External Fixators / Q000592:standards / Q000639:trends; D005260:Female; D005539:Foramen Magnum / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D016268:Internal Fixators / Q000592:standards / Q000639:trends; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D019547:Neck Pain / Q000209:etiology / Q000503:physiopathology; D009809:Odontoid Process / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery; D010985:Platybasia / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011782:Quadriplegia / Q000209:etiology / Q000503:physiopathology; D013117:Spinal Cord Compression / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D014057:Tomography, X-Ray Computed; D014143:Traction / Q000295:instrumentation* / Q000379:methods / Q000592:standards; D016896:Treatment Outcome