Halo Vest Immobilization: Is It Still a Valid Treatment for Atlantoaxial Fractures?

Background: Atlantoaxial injuries pose a significant threat to morbidity and mortality. This retrospective study aims to analyze clinical and radiologic results, failure rates, and complications in a series of patients treated with a halo vest, validating the effectiveness of this device through long-term follow-up.

Methods: This study reviewed adult patients with acute upper cervical spine injuries treated with halo vest immobilization from 1994 to 2022. Fracture types were classified based on computed tomography characteristics. Clinical and radiologic follow-up was performed at the end of treatment and 3 months after the removal of the system.

Results: Most treated patients were male (70%), with a mean age of 38 years. Car accidents were the primary cause of injury (63%). Among 161 patients, 134 had a C2 fracture, 20 had a C1 fracture, 5 had a C1-C2 rotational dislocation, and 2 had other unclassified combined C1/C2 fractures. Patients without additional injuries or neurologic deficits had significantly shorter hospitalization (8 vs. 16 days and 12 vs. 22 days, respectively) compared with those with additional injuries (P < 0.00001) or neurologic deficits (P = 0.00164). At 6 months follow-up, radiologic and clinical outcomes were available for 147 patients. Radiography in 139 cases showed fracture fusion (94.6%). Clinical follow-up showed a normal or slightly reduced range of motion in 144 cases (98%). Pain was absent or episodic in all the patients except one. In 131 patients (89%), an excellent or good clinical result was achieved. Complications did not affect treatment.

Conclusions: Based on our results, the halo vest is a valid treatment for atlantoaxial injuries in selected patients. These patients include young and middle-aged individuals (up to 65 years old) with C1 and/or C2 fractures. Halo vest treatment is associated with minor complications and yields a high percentage of excellent/good clinical results.