Complications of halo use in children.

Abstract

STUDY DESIGN:

Retrospective review.

OBJECTIVE:

To evaluate complications of halo use in children.

SUMMARY OF BACKGROUND DATA:

Halos have been used in children for correction of spinal deformity and immobilization of the spine. Complications of halo use in children have been reported, including pin-site complications and neurologic injury from halo traction. The purpose of this report is to report on complications of halo use in children.

METHODS:

The medical records of 68 patients treated with a halo for correction of spinal deformity or immobilization from 1996 to 2005 were reviewed. Mean age of children was 10 (1-20) years. The halo device was used to apply traction for correction of spinal deformity in 31 patients, and immobilization alone with halo vest in 37 patients.

RESULTS:

The overall rates of complications are significant at 53% (36/68). Pin-site complications included 13 infections successfully treated with oral antibiotics and 4 pins that needed to be removed. Two pins were replaced due to skull penetration, and 1 scar site was surgically revised. There were a total of 9 neurologic complications that occurred in 7 of 31 patients undergoing halo traction (31% incidence), including 3 cranial nerve injuries, 1 Horner syndrome, 4 extremity weaknesses, and 1 bradycardia. All traction-related neurologic problems resolved with removal or decrease of the magnitude of traction, with 4 cases improving immediately, 3 cases within 2 days, and the 2 other cases resolving in 1 and 5 months. Lastly, there were 7 vest-related complications including 5 pressure sores, 1 cracking of the vest, and 1 halo-vest readjustment.

CONCLUSION:

This is the largest reported series of halo use in children. The overall rate of complications is 53% (36/68), and 10% (7/68) of children required unanticipated surgery for treatment of these complications. The most common complication was pin-site infections, with 76% (13/17) of these resolving with oral antibiotics alone. Traction-related neurologic injuries that occurred were common, 31% (9/31) but all resolved with a decrease or removal of traction weight, with complete resolution occurring immediately in 4 of 9 events. We recommend serial neurologic examinations of children in halo traction, with immediate removal or decrease in weights at the first sign of injury.

• Authors: Noppachart Limpaphayom, David L Skaggs, Gordon McComb, Mark Krieger, Vernon T Tolo
• Journal: Spine (Spine (Phila Pa 1976)) Vol. 34 Issue 8 Pg. 779-84 (Apr 15 2009) ISSN: 1528-1159 [Electronic] United States
• PMID: 19337133 (Publication Type: Journal Article)

Topics

• Adolescent
• Child
• Child, Preschool
• Female
• Humans
• Infant
• Male
• Postoperative Complications (etiology)
• Risk Assessment (statistics & numerical data)
• Spinal Diseases (surgery)
• Traction (adverse effects, instrumentation, methods)
• Young Adult