The effectiveness of the cervical halo: open versus closed ring. A preliminary report

The halo cervical orthosis has proven extremely effective in stabilizing the spine, both non-operatively and as a supplement to operative procedures. Current designs of the available halo utilize either a closed or an open stabilizing ring. Twenty-four patients with various indications for halo application are reviewed. Eleven were treated with a closed ring apparatus (Ace Medical, Los Angeles, California), and thirteen with an open ring device (Bremer, Inc, Jacksonville, Florida). X-rays of the treated patients were compared by group, and patients were interviewed regarding their complaints while wearing the halo. Rates of complication were compared. Results showed no significant differences between radiographs (kyphosis or translation) throughout the follow-up period. Patients experienced a significantly higher incidence of halo-associated pain in the open group. Otherwise, there were no statistical differences in the complication rates of either device. Whether or not the higher incidence of pain in the open group is related to decreased device rigidity is unknown. The open design may theoretically permit bending and opening of the ring to occur, the so-called 'wishbone' effect. Based on these data, it cannot be determined whether the advantages of the open ring--ease of application--are offset by this potential disadvantage. Clearly, a larger, randomized prospective study is required to investigate this.