[Halo-fixator vest--indications and complications]

Over the period between 06/00 and 03/03, 41 patients with different injuries of the upper cervical spine were treated by a halo fixator and were statistically recorded. The collective showed different injury patterns, 2 fractures of occiput condyles (5%), 3 Jefferson fractures (7%), 1 combined injury of the odontoid process and an atlas fracture (2%), 32 odontoid fractures (78%), 2 hanged-man-fractures Typ Effendi II (5%) and one case of pathologic fractures from the 2. to the 4. cervical vertebral body based on a plasmocytoma (2%). 31 of 41 patients could be examined for a follow up; 40 complete medical histories were well documented and could be analysed. As complications we had screw loosening in 6 cases (15%), a complete tear out of screws in 2 cases (5%). One patient took the halo away by himself two times, so after the second time surgical stabilisation was performed (2,5%). One case of intracranial penetration of a screw happened after the patient fell down in an accident with the halo (2,5%). Infection of the screw pins appeared in 4 cases (10%) and we had 2 cases of skin necrosis (5%). A second reduction after redisplacement was necessary in 8 cases (20%). 23 patients suffered from pain at the insertion of the screws (75%) and 18 patients complained of pressure in the head (58%). On the question of the comfort of this kind of therapy answered 18 patients with "intolerable" (58%), 10 patients with middle (32%) and 3 patients with tolerable (10%). Despite of the large number of different complications and the miscomfort of a halo fixator we think that there are still indications for treatment of special injuries of the upper cervical spine with a halo fixator. One important aspect is the lack of adequate alternatives even with regard to the biomechanical stability.