title: Halo vest treatment of cervical spine injuries: a success and survivorship analysis.
abstract: METHODS
  A retrospective study of a consecutive series of traumatic cervical spine injuries treated with halo vest immobilization (HVI) over an 8-year period at a level 1 trauma center.
  
  
  OBJECTIVE
  To assess survivorship, success, and causes of failure of HVI in the management of cervical spine injuries.
  
  
  BACKGROUND
  The use of HVI has been increasingly questioned as an immobilization technique in cervical trauma due to reports of high complication rates and unacceptable treatment results. It was our hypothesis that selective use of updated HVI could demonstrate higher clinical success rates and lower complication rates compared to several previous landmark studies.
  
  
  METHODS
  All patients with traumatic cervical spine injuries treated with HVI between 1998 and 2006 at a single level 1 trauma center were reviewed retrospectively. With Internal Review Board approval, the trauma, spine, and orthotics databases were reviewed for (1) injury type, (2) patient age, (3) complications and comorbidities, (4) survivorship of the device and (5) treatment outcome.
  
  
  RESULTS
  Four hundred ninety traumatic cervical spine injuries in 342 patients were treated with HVI. Thirty-one (9%) patients were lost to follow-up. Average age was 41 years (2-94). HVI was used as definitive treatment in 288 (84%) patients and in conjunction with surgical intervention in 54 (16%) patients. One hundred thirteen (35%) complications occurred, the most common of which were pin site infections (39) and instability (38). Two hundred seven (74%) of the 289 halo survivors with appropriate follow-up completed the initially prescribed time period of HVI. Two hundred eight of 247 (85%) halos placed as stand-alone management achieved their intended goal.
  
  
  CONCLUSIONS
  Treatment with HVI was successful in 85% of patients and 74% of survivors completed their intended treatment period. Complications, though common, were mostly not severe. HVI is still a reasonable treatment option in managing cervical spine injuries.
authors.affiliation: Department of Orthopaedics and Sports Medicine, Harborview Medical Center, University of Washington, Seattle, WA 98104, USA. rbransfo@u.washington.edu
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Bransford
authors.forename: David W
authors.initials: DW
authors.lastname: Stevens
authors.forename: Staci
authors.initials: S
authors.lastname: Uyeji
authors.forename: Carlo
authors.initials: C
authors.lastname: Bellabarba
authors.forename: Jens R
authors.initials: JR
authors.lastname: Chapman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000293:injuries*; D002648:Child; D002675:Child, Preschool; D016267:External Fixators / Q000009:adverse effects / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D011542:Pseudarthrosis / Q000453:epidemiology; D012189:Retrospective Studies; D013124:Spinal Injuries / Q000401:mortality / Q000601:surgery*; D013530:Surgical Wound Infection / Q000453:epidemiology; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult