title: Upper cervical spine injuries: indications and limits of the conservative management in Halo vest. A systematic review of efficacy and safety.
abstract: BACKGROUND
  The integrity of the upper cervical spine is essential for survival and function, because of the neurovascular structures contained within its bony elements. Fractures of the upper cervical spine (C1-C2) are frequent. This systematic review assesses the efficacy and safety of the conservative management in Halo vest for patients with upper cervical spine fractures.
  
  
  METHODS
  Two reviewers independently identified studies in English, by a systematic search of CINAHL, Embase, Medline, HealthSTAR, and the Cochrane Central Registry of Controlled Trials, from inception of each database to 28 January 2010, using various combinations of the keywords terms "odontoid fractures", hangman's fractures", "axis fractures", "axis", "atlas", "Jefferson fractures", "C1 arch fractures", "C1 fractures", "C2 fractures", "cervical spine", "injuries", "fracture", "trauma", "neck injury", "surgery".
  
  
  RESULTS
  A total of 43 citations were obtained. An additional 4 papers were obtained from the reference list of the studies included. The 47 studies that were included described a total of 1078 patients with C1-C2 fractures managed by halo fixator.
  
  
  CONCLUSIONS
  The halo fixator has a well defined place in the management of fractures of the cervical spine. Clearly, studies of higher level of evidence, for instance large randomised trials, should be conducted, even though the available evidences suggest that management of upper cervical spine fracture with halo fixator is safe and effective.
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria Rome, Italy. g.longo@unicampus.it
authors.forename: Umile Giuseppe
authors.initials: UG
authors.lastname: Longo
authors.forename: Luca
authors.initials: L
authors.lastname: Denaro
authors.forename: Stefano
authors.initials: S
authors.lastname: Campi
authors.forename: Nicola
authors.initials: N
authors.lastname: Maffulli
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Denaro
mesh_terms: D002574:Cervical Vertebrae / Q000293:injuries*; D016267:External Fixators; D005260:Female; D017102:Fracture Healing / Q000502:physiology; D006801:Humans; D007103:Immobilization / Q000295:instrumentation* / Q000379:methods; D008297:Male; D016103:Spinal Fractures / Q000145:classification / Q000000981:diagnostic imaging / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome