İhsan CANBEK, Olcay ESER, Adem ASLAN, Ergün KARAVELİOĞLU

Üst servikal vertebra fraktürlerinde Halo Vest uygulaması

Amaç: Bu çalışmada üst servikal vertebra fraktürü nedeniyle cerrahi uygulanmayan hastalarda Halo Vest uygulamasının etkinliğini, uzun dönem sonuçlarını, eşlik eden komplikasyonlarını ve hasta memnuniyetini araştırdık.Yöntemler: 2006-2011 yılları arasında travma sonrasıüst servikal vertebra fraktürü nedeniyle kliniğimizde HaloVest uygulanan 11’i erkek 2’si bayan toplam 13 hasta çalışmaya alınmıştır. Hastaların işlem öncesi ve sonrası klinik ve radyoljik bulguları da analiz edilmiştir.Bulgular: Halo Vest uygulanan 13 hastanın 6 tanesindeizole odontoid Tip 3 kırığı, 2 tanesinde odontoid Tip 2 veC1 Tip 1 kırığı, 2 tanesinde odontoid Tip 2 ve Jeffersonkırığı, 1 tanesinde Tip 2 asılmış adam kırığı ve 2 tanesinde de sınıflandırılamayan C2 korpus kırığı mevcuttu.Hastalar Halo Vest immobilizasyon ile ortalama 14 hafta(10-21 hafta) takip edilmiştir. 10 hastada füzyon gelişmişolup ortalama süre 12 haftaydı.Sonuç: Üst servikal vertebra fraktürlerinde Halo Vest uygulaması güvenilir ve etkili bir tedavi yöntemi olmakla birlikte, hasta konforu ve memnuniyeti düşüktür.

Halo Vest treatment of upper cervical vertebral fracture

Objective: In this study we aimed to investigate the efficacy, long term result and associated complications of Halo Vest treatment for patients with upper cervical spine fractures. Methods: This study included 13 patients (11 men and 2 women) who applied Halo Vest treatment for traumatic upper cervical vertebral fracture between 2006 and 2011. We reviewed the radiological and clinical findings of patients before and after the treatment. Results: Six of 13 patients had odontoid type 3 fracture, 2 patients had odontoid type 2 fracture with C1 type 1 fracture, 2 patients had odontoid type 2 fracture with Jefferson fracture, one patient had type 2 hangman fracture and two patients had unclassified C2 corpus fractures. The mean follow-up time with Halo Vest was 14 weeks (10-21 weeks). Ten patients had bone fusion and the mean time of bone fusion was 12 weeks. Conclusions: Halo Vest treatment for upper cervical spine fracture is a safe and effective method but the patients comfort and satisfaction are low.

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1. Shin JJ, Kim SJ, Kim TH, et al. Optimal use of the halovest orthosis for upper cervical spine injuries. Yonsei Med J 2010;51:648-652.
2. Longo UG, Denaro L, Campi S, et al. Upper cervical spine injuries: indications and limits of the conservative management in Halo vest. A systematic review of efficacy and safety. Injury 2010;41:1127-1135.
3. Dickman CA, Hadley MN, Browner C, Sonntag VK. Neurosurgical management of acute atlas-axis combination fractures. A review of 25 cases. J Neurosurgery 1989;70:45-49.
4. Perry J, Nickel VL. Total cervical fusion for neck paralysis. J Bone Joint Surg 1959;41:37-60.
5. Lauweryns P. Role of conservative treatment of cervical spine injuries. Eur Spine J 2010;19 (Suppl 1):523- 526.
6. Glaser JA, Whitehill R, Stamp WG, Jane JA. Complications associated with the halo-vest. A review of 245 cases. J Neurosurg 1986;65:762-769.
7. Guiot B, Fessler RG. Complex atlantoaxial fractures. J Neurosurg 1999;91:139-143.
8. Kim DH, Vaccaro AR, Affonso J, et al. Early predictive value of supine and upright X-ray films of odontoid fractures treated with halo-vest immobilization. Spine J 2008;8:612-618.
9. Ochoa G. Surgical management of odontoid fractures. Injury 2005;36 Suppl 2:B54-64.
10. Rockswold GL, Bergman TA, Ford SE. Halo immobilization and surgical fusion: relative indications and effectiveness in the treatment of 140 cervical spine injuries. J Trauma 1990;30:893-898.
11. Majercik S, Tashjian RZ, Biffl WL, et al. Halo vest immobilization in the elderly: a death sentence? J Trauma 2005;59:350-356.
12. Vieweg U, Schultheiss R. A review of halo vest treatment of upper cervical spine injuries. Arch Orthop Trauma Surg 2001;121:50-55.
13. Garfin SR, Botte MJ, Waters RL, Nickel VL. Complications in the use of the halo fixation device. J Bone Joint Surg Am 1986;68:320-325.
14. Lind B, Sihlbom H, Nordwall A. Halo-vest treatment of unstable traumatic cervical spine injuries. Spine (Phila Pa 1976) 1988;13:425-432.
15. Nickel VL, Perry J, Garrett A, Heppenstall M. The halo. A spinal skeletal traction fixation device. J Bone Joint Surg Am 1968;50:1400-1409.
16. Houtkin S, Levine DB. The halo yoke: a simplified device for attachment of the halo to a body cast. J Bone Joint Surg Am 1972;54:881-883.
17. Bransford RJ, Stevens DW, Uyeji S, et al. Halo Vest treatment of cervical spine injuries. Spine 2009;34:1561-1566.
18. Dormans JP, Criscitiello AA, Davidson RS. Complications in children managed with immobilization in a Halo Vest. J Bone Joint Surg 1995;77-A:1370-1373.