title: Complications of halo use in children.
abstract: METHODS
  Retrospective review.
  
  
  OBJECTIVE
  To evaluate complications of halo use in children.
  
  
  BACKGROUND
  Halos have been used in children for correction of spinal deformity and immobilization of the spine. Complications of halo use in children have been reported, including pin-site complications and neurologic injury from halo traction. The purpose of this report is to report on complications of halo use in children.
  
  
  METHODS
  The medical records of 68 patients treated with a halo for correction of spinal deformity or immobilization from 1996 to 2005 were reviewed. Mean age of children was 10 (1-20) years. The halo device was used to apply traction for correction of spinal deformity in 31 patients, and immobilization alone with halo vest in 37 patients.
  
  
  RESULTS
  The overall rates of complications are significant at 53% (36/68). Pin-site complications included 13 infections successfully treated with oral antibiotics and 4 pins that needed to be removed. Two pins were replaced due to skull penetration, and 1 scar site was surgically revised. There were a total of 9 neurologic complications that occurred in 7 of 31 patients undergoing halo traction (31% incidence), including 3 cranial nerve injuries, 1 Horner syndrome, 4 extremity weaknesses, and 1 bradycardia. All traction-related neurologic problems resolved with removal or decrease of the magnitude of traction, with 4 cases improving immediately, 3 cases within 2 days, and the 2 other cases resolving in 1 and 5 months. Lastly, there were 7 vest-related complications including 5 pressure sores, 1 cracking of the vest, and 1 halo-vest readjustment.
  
  
  CONCLUSIONS
  This is the largest reported series of halo use in children. The overall rate of complications is 53% (36/68), and 10% (7/68) of children required unanticipated surgery for treatment of these complications. The most common complication was pin-site infections, with 76% (13/17) of these resolving with oral antibiotics alone. Traction-related neurologic injuries that occurred were common, 31% (9/31) but all resolved with a decrease or removal of traction weight, with complete resolution occurring immediately in 4 of 9 events. We recommend serial neurologic examinations of children in halo traction, with immediate removal or decrease in weights at the first sign of injury.
authors.affiliation: Division of Orthopedic Surgery, Children's Hospital Los Angeles, Los Angeles, California 90027, USA.
authors.forename: Noppachart
authors.initials: N
authors.lastname: Limpaphayom
authors.forename: David L
authors.initials: DL
authors.lastname: Skaggs
authors.forename: Gordon
authors.initials: G
authors.lastname: McComb
authors.forename: Mark
authors.initials: M
authors.lastname: Krieger
authors.forename: Vernon T
authors.initials: VT
authors.lastname: Tolo