Diminishing usage of halo-vest orthoses: Characterization of evolving trends

Halo-vest orthoses may be considered for spinal immobilization and deformity correction. Recent usage patterns remain poorly characterized. Patients receiving halo-vest orthoses were identified from the 2010 to 2022 M170Ortho PearlDiver database. Yearly trends and overall distributions of utilization rates, Elixhauser Comorbidity Index (ECI), sex, primary indications, and rates/timing of subsequent surgery.

Usage and patient ages were trended over the years and characterized. Patients were further subcategorized as pediatric (<18 years), adult (18-65 years), and geriatric (>65 years). Across age cohorts, trends and distributions of ECI, sex, primary indications, and rates/timing of subsequent surgery were determined. Simple linear regression with overall F-tests and Kaplan-Meier survival analyses with log-rank tests were used to determine differences.

A total of 6,016 patients receiving halo-vest orthoses were identified. From 2010 to 2022, halo utilization declined 69.1% (p<.001) and average patient age declined from 48.9 to 38.8 (p=.001). Of these, 1,334 (22.2%) were pediatric, 2,830 (47.0%) were adult, and 1,852 (30.8%) were geriatric. Pediatric proportion of use increased (p<.001), while adult and geriatric use decreased (p=.002; p<.001) over the years. Average ECI increased across all age groups (p<.001).Spinal deformity was the most common indication in the pediatric population, while upper cervical fractures were most common in the adult and geriatric populations. Of the 37.2% of pediatric patients who proceeded to subsequent surgery, half were within 25 days, and of the 20.6% of geriatric patients undergoing subsequent surgery, half were within 1 week.

The current study characterized the decreasing use of halo-vest orthosis over the years, with greatest use for younger patients with deformity and older patients with upper cervical fractures. More recently, usage in the pediatric population has surpassed usage in the geriatric population. Of those going onto subsequent surgery, most were early, suggesting use as a temporizing or reduction measure.