title: Stable reconstruction using halo vest for unstable upper cervical spine and occipitocervical instability.
abstract: BACKGROUND
  Upper cervical or occipitocervical disorders such as rheumatoid arthritis present as atlantoaxial subluxation, vertical subluxation of the axis, and subaxial subluxation, which produce myelopathy and severe pain. In such cases, occipitocervical reconstruction surgery may be indicated, and several reports have described reduction of subluxation by fixing the halo vest before this surgery.
  
  
  OBJECTIVE
  The purpose of this study was to evaluate the efficacy of using the halo vest before the surgery for unstable upper cervical spine and for occipitocervical instability.
  
  
  METHODS
  Twenty-eight patients (9 men and 19 women; mean age, 61.8 years at surgery) who presented with atlantoaxial or occipitocervical fusion were studied. In all cases, the halo vest was fixed in the conscious condition, and subluxation was reduced before the surgery. The mean follow-up period was 45 months. Roentgenologic measurement and clinical evaluation were performed before the surgery and at the final follow-up.
  
  
  RESULTS
  Using the halo vest resulted in significant reductions in the atlantodental interval, the space available for the spinal cord, and the Ranawat value (p < 0.05), and these were maintained until the final follow-up. The mean Japanese Orthopedic Association score significantly improved from 9.5 before surgery to 12.2 at the final follow-up (p = 0.01). Nineteen cases (68%) improved by more than 1 grade by Ranawat's classification after surgery and 16 cases (57%) maintained the same at the follow-up visit.
  
  
  CONCLUSIONS
  Conscious preoperative reduction using the halo vest for occipitocervical disorders is a useful and safe technique.
authors.affiliation: Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto-city, Nagano 390-8621, Japan. nbogi@shinshu-u.ac.jp
authors.forename: Nobuhide
authors.initials: N
authors.lastname: Ogihara
authors.forename: Jun
authors.initials: J
authors.lastname: Takahashi
authors.forename: Hiroki
authors.initials: H
authors.lastname: Hirabayashi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Hashidate
authors.forename: Keijiro
authors.initials: K
authors.lastname: Mukaiyama
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kato
mesh_terms: D000368:Aged; D001268:Atlanto-Axial Joint / Q000000981:diagnostic imaging; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009777:Occipital Bone / Q000000981:diagnostic imaging; D009983:Orthopedic Equipment; D011859:Radiography