Related Experiment Video
Updated: Jun 24, 2026
Quantitative Assessment of Cortical Auditory-tactile Processing in Children with Disabilities
Published on: January 29, 2014
Analysis of halo-orthoses application in children less than three years old
Alexandre Arkader1, Harish S Hosalkar, Denis S Drummond
1Department of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Insights
Halo immobilization is safe and effective for young children needing upper cervical spine stabilization. This method offers mechanical advantages, with benefits outweighing risks when developmental anatomy is considered.
Area of Science:
- Pediatric Orthopedics
- Neurosurgery
- Spinal Surgery
Background:
- Halo immobilization is crucial for pediatric spinal trauma and congenital conditions.
- Assessing its safety and efficacy in very young children (<3 years) is essential due to unique developmental anatomy.
Purpose of the Study:
- To evaluate the safety and efficacy of halo-orthosis immobilization in children younger than 3 years.
- To analyze indications, functional outcomes, and complications associated with halo use in this pediatric population.
Main Methods:
- Retrospective review of 10 patients (<3 years) treated with halo-orthosis at a tertiary pediatric center.
- Evaluation of immobilization adequacy considering skull and brain development, alongside functional outcome analysis.
Main Results:
- Two halo-related issues (pin-site infection, pin loosening) and four index procedure complications (pseudarthrosis, insufficient decompression) were noted.
- Two of three failed fusions occurred at the occipito-cervical junction, leading to technique development for this area.
Conclusions:
- Halo-orthosis is a safe and reliable device for upper cervical spine immobilization in children under 3.
- Recommendations include understanding developmental anatomy, using CT scans for pin placement, multiple pins, precise tightening, and diligent follow-up.
Purpose:
To evaluate the safety and efficacy of halo immobilization in children younger than 3 years.
Methods:
All children less than 3 years of age who were placed in a halo-orthosis at a tertiary pediatric center were reviewed to determine the indications, safety, and efficacy of this method. Adequacy of immobilization and correct technique was established considering the chronology of maturation (skull and brain development). The functional outcome was analyzed.
Results:
Ten patients (<3 years old) were identified from a total of 150 where halo ring/vest immobilization was used. There were six boys and four girls, with an average age of 2 years (range 10 months to 2 years and 10 months). The average time of immobilization in the halo-orthosis was 75 days (range 33-168 days), and the average follow-up time was 5 years and 2 months (range 1-12 years). There were two halo-related problems and four related to the index procedure. Halo-related problems included pin-site infection in one patient, and three pins loosening in another. There were four complications associated with the index procedure, all early in the series, including three cases of pseudarthrosis and one patient that had an insufficient decompression of basilar invagination. Two of the three failed fusions occurred at the occipito-cervical junction, which prompted us to develop new techniques for fusion at this level.
Conclusions:
Halo-orthosis is a relatively safe and reliable device for immobilization of the upper cervical spine in children less than 3 years old. Understanding the developmental anatomy and a limited CT scan are helpful in pin placement. We recommend the use of a multiple pin construct, perpendicular insertion, and precise tightening with good pin-site care and frequent follow-up. The benefits seem to outweigh the risks in this population, considering the mechanical advantages of the halo-orthosis.
