Halo vest immobilisation for subaxial cervical spine injuries: a retrospective case series

Subaxial cervical spine injuries are commonly managed in cervical collars but these may not provide sufficient support for some injuries. Surgical stabilisation carries both immediate and longer-term risks. Halo vest immobilisation (HVI) has been widely documented in the management of upper cervical spine injuries but there is less data regarding its use for subaxial injuries. The objective of this study was to investigate complications and outcomes associated with HVI for subaxial cervical spine injuries.

A retrospective review of patients with subaxial cervical spine injuries, treated with HVI between 2016 and 2021, and followed-up in a dedicated "halo clinic", was performed. Data relating to demographics, injury and follow-up were collected. Patients in whom HVI was used as an adjunct to surgical management for upper cervical or isolated thoracic injuries were excluded.

46 patients (67% male) with a median age of 33 years were included. Four (9%) were lost to follow-up. Median time of HVI was 80 days. Three patients (6.5%) underwent subsequent surgery. Two, with multi-level injuries, underwent a single and two-level anterior cervical discectomy and fusion for ongoing instability. One patient underwent multi-level posterior fusion due to early loss of alignment with HVI. Other complications included four pin site infections (9%) and seven pin loosening (15%).

HVI can be utilised to manage subaxial cervical spine injuries with careful follow-up. There may be a role in reducing the requirement for multi-level fusion in multi-level injuries, however, future prospective trials are required to elucidate this. Further investigation is required to ascertain patient reported outcomes comparing HVI to surgical management for subaxial cervical spine injuries in the long term.