Halo vest fixation effectively maintains cervical alignment through intraoperative repositioning in patients with cervical spine instability
Takafumi Arita,
Osamu Kawano,
Hiroaki Sakai,
Yuichiro Morishita,
Muneaki Masuda,
Tetsuo Hayashi,
Kensuke Kubota,
Takeshi Maeda,
Yasuharu Nakashima,
Kazuya Yokota
Affiliations
Takafumi Arita
Department of Orthopaedic Surgery, Japan Labor Health and Welfare Organization Spinal Injuries Center, 550-4 Igisu, Iizuka, Fukuoka, 820-0053, Japan
Osamu Kawano
Department of Orthopaedic Surgery, Japan Labor Health and Welfare Organization Spinal Injuries Center, 550-4 Igisu, Iizuka, Fukuoka, 820-0053, Japan
Hiroaki Sakai
Department of Orthopaedic Surgery, Japan Labor Health and Welfare Organization Spinal Injuries Center, 550-4 Igisu, Iizuka, Fukuoka, 820-0053, Japan
Yuichiro Morishita
Department of Orthopaedic Surgery, Japan Labor Health and Welfare Organization Spinal Injuries Center, 550-4 Igisu, Iizuka, Fukuoka, 820-0053, Japan
Muneaki Masuda
Department of Orthopaedic Surgery, Japan Labor Health and Welfare Organization Spinal Injuries Center, 550-4 Igisu, Iizuka, Fukuoka, 820-0053, Japan
Tetsuo Hayashi
Department of Orthopaedic Surgery, Japan Labor Health and Welfare Organization Spinal Injuries Center, 550-4 Igisu, Iizuka, Fukuoka, 820-0053, Japan
Kensuke Kubota
Department of Orthopaedic Surgery, Japan Labor Health and Welfare Organization Spinal Injuries Center, 550-4 Igisu, Iizuka, Fukuoka, 820-0053, Japan
Takeshi Maeda
Department of Orthopaedic Surgery, Japan Labor Health and Welfare Organization Spinal Injuries Center, 550-4 Igisu, Iizuka, Fukuoka, 820-0053, Japan
Yasuharu Nakashima
Departments of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashiku, Fukuoka, 812-8582, Japan
Kazuya Yokota
Department of Orthopaedic Surgery, Japan Labor Health and Welfare Organization Spinal Injuries Center, 550-4 Igisu, Iizuka, Fukuoka, 820-0053, Japan; Departments of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashiku, Fukuoka, 812-8582, Japan; Corresponding author. Department of Orthopaedic Surgery, Japan Labor Health and Welfare Organization Spinal Injuries Center, 550-4 Igisu, Iizuka, Fukuoka, 820-0053, Japan.
Introduction: The objective of this study was to examine if halo vest fixation provides sufficient stabilization of cervical spine alignment to endorse its use through intraoperative positional changes in patients with cervical spine instability. Methods: The subjects of this study were 14 patients with cervical spine instability who were immobilized in halo vests until they underwent subsequent internal fixation surgery. After induction of anesthesia, the patients in halo vests were repositioned from the supine position to the prone position. The halo ring was fixed to the surgical table and the dorsal struts and vest were removed for surgery. Radiographs obtained in the preoperative sitting position and intraoperative prone position were compared for the following measures of cervical alignment: O–C2 angle, C2–C6 angle, pharyngeal inlet angle (PIA), atlantodental interval (ADI), Redlund-Johnell (R–J) value as a measure of O–C2 length, O–C6 length, and O–C2 length/O–C6 length (%). Results: There were no significant differences in O–C2 angle, C2–C6 angle, PIA, ADI, or O–C2 length/O–C6 length (%). However, the R–J value and O–C6 length were significantly higher in the intraoperative prone position than in the preoperative sitting position. None of the patients presented with any complications, including dysphagia or neurological deterioration. Conclusions: Our results suggest that when patients are repositioned to the prone position while immobilized in halo vests, the cervical spine is distracted in the cephalocaudal direction across all cervical segments but the cervical alignment is sufficiently maintained. Halo vests are a highly effective external fixation method for patients with cervical spine instability, allowing for a safe repositioning to the prone position for surgery while preserving cervical alignment and preventing neurological deterioration.
