title: Use of a noninvasive halo in children.
abstract: METHODS
  Retrospective review of clinical experience in children using a new noninvasive halo.
  
  
  OBJECTIVE
  To report on the efficacy, complications and indications for use of a noninvasive halo in the pediatric population.
  
  
  BACKGROUND
  A halo vest with pins in the skull is the gold standard for providing maximum immobilization and control of the cervical spine. Inherent complications include scarring, infection, cerebral spinal fluid leakage, loosening of pins, and penetration of the cranial vault. Less invasive orthoses historically provide significantly less immobilization and control of the cervical spine. A Minerva cast has problems with patient tolerance and skin care.
  
  
  METHODS
  The noninvasive halo was used on 30 children (ages 6 months to 16 years) for the following indications: muscular torticollis release, 18 children; cervical fusion immobilization 7 children; closed reduction of C1-C2 rotatory subluxation, 5 children.
  
  
  RESULTS
  The noninvasive halo was successful with no complications in 29 of 30 patients. One complication consisted of dislodgment of a C2-C4 anterior strut graft, though fusion ensued without further surgery and the clinical result was successful. Longstanding C1-C2 rotatory subluxations were safely reduced in 5 children with the noninvasive halo. In 18 children following sternocleidomastoid release, the cervical spine was successfully immobilized in an overcorrected position after surgery.
  
  
  CONCLUSIONS
  A noninvasive halo was used successfully for postoperative immobilization of children with stable cervical spines. This device was particularly useful for the gentle and safe reduction of C1-C2 subluxations, and for postoperative immobilization in an overcorrected position following stenocleidomastoid release for congenital muscular torticollis.
authors.affiliation: Division of Orthopedics, Childrens Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA 90027, USA. dskaggs@chla.usc.edu
authors.forename: David L
authors.initials: DL
authors.lastname: Skaggs
authors.forename: Lawrence D
authors.initials: LD
authors.lastname: Lerman
authors.forename: Josh
authors.initials: J
authors.lastname: Albrektson
authors.forename: Max
authors.initials: M
authors.lastname: Lerman
authors.forename: David G
authors.initials: DG
authors.lastname: Stewart
authors.forename: Vernon T
authors.initials: VT
authors.lastname: Tolo
mesh_terms: D000293:Adolescent; D001915:Braces; D002574:Cervical Vertebrae / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007103:Immobilization / Q000295:instrumentation*; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000601:surgery*; D016896:Treatment Outcome