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Published on: February 10, 2026
Complications and problems in halo treatment of toddlers: limited ambulation is recommended
Michelle S Caird1, Robert N Hensinger, Nicole Weiss
1Orthopaedic Surgery Department, University of Michigan, Ann Arbor, MI 48109 USA. sugiyama@med.umich.edu
Insights
Halo ring fixation is safe for young children (3 years and younger), with complication rates comparable to older patients. Pin site infections and falls were the most common issues, but manageable.
Area of Science:
- Pediatric Orthopedics
- Neurosurgery
- Spinal Surgery
Background:
- Halo ring fixation is a common orthopedic device for stabilizing severe cervical spine injuries.
- Limited data exists on its efficacy and safety in children aged 3 years and younger.
Purpose of the Study:
- To evaluate the safety and complication profile of halo ring fixation in children aged 3 years and younger.
Main Methods:
- Retrospective review of 13 patients aged 3 years and younger treated with halo ring fixation.
- Data collected on indication for fixation, ring/vest customization, pin fixation details, and complications.
Main Results:
- The 13 patients (average age 26 months) were treated for trauma, post-cervical arthrodesis stabilization, or scoliosis traction.
- Nine patients (69%) experienced complications, primarily pin site infections (6) and falls (3).
- No post-treatment skull deformities were observed; only one patient required further surgery.
Conclusions:
- Halo ring fixation is a safe and effective treatment for children aged 3 years and younger.
- Complication rates are similar to older pediatric populations, with pin site issues being most common.
- Recommendations include considering increased fall risk and advising limited ambulation in this age group.
Abstract:
Although halo fixation in children aged 3 years or younger is described, no study has reported results in this age group. A retrospective review was conducted among children aged 3 years and younger and treated with halo ring fixation. Thirteen patients were identified, with an average age of 26 months (range, 16-43 months) at halo application. Six patients were treated for trauma, 6 for stabilization after cervical arthrodesis, and 1 for traction for progressive infantile scoliosis. All the children required custom or modified rings and vests. On average, 8 pins (range, 6-12) were used for fixation with torque from 2 to 4 in-lbs. Nine (69%) of the 13 patients had complications including 6 pin infections, 3 falls, and 1 respiratory difficulty. Only 1 child required further surgery. None developed posttreatment skull deformity. Halo ring fixation is safe in children aged 3 years and younger and has a complication rate similar to that in older children. Pin problems can be treated effectively by standard means. Unique to this age group, toddlers may be more prone to falls than older children, and limited ambulation should be recommended.
