Halo rings, halo cervical traction and vests

What are halo rings, halo cervical traction and vests?

Halo rings, halo cervical traction and vests are external fixator treatments (rigid immobilisation) used for certain types of neck injuries/spinal disorders.

Cervical (neck) spine injuries

Cervical (neck) spine injuries are caused by:

• trauma/violence
• motor vehicle accidents
• falls
• sporting accidents
• tumours
• infections.

Fracture, dislocation, subluxation

Neck injuries can result in fractures, dislocations, subluxations (bones moving out of normal position) or a combination of these injuries to the vertebrae (bones in the neck).

Joints and ligaments can also be involved. Ligaments hold the cervical spine in the correct position. Ligament disruption can result in the cervical spine becoming unstable and increase the risk of damage to the spinal cord.

Some neck injuries can result in neurological deficits (loss of movement and sensation below the point where the spine was injured) if the spinal cord is involved. The higher the spine injury occurs, then the greater the amount of function that can be lost. Loss of function can be permanent.

Injuries are diagnosed and evaluated using physical examination and X-rays or scans.

Bone and ligament healing

Healing takes between 8 to 16 weeks. To aid the healing process, the cervical spine needs to be positioned in the correct alignment, stabilised and immobilised.

Halo ring/traction (external fixator)

Halo rings are predominately used for injuries to the upper part of the spine (neck). Halo rings provide rigid immobilisation of the neck and head and can be used as a stand-alone treatment or following surgery. They are used with traction or fitted to a vest.

Application of the halo ring

The Halo Ring is usually made of carbon fibres and is fixed to the head using 4 ‘pins'. Insertion of the pins may be done on the ward or in theatre. The procedure usually takes about 30 minutes. A local anaesthetic is used at the pin sites prior to insertion.

Skull pins

Pins are checked and tightened after 24 hours and then every 7 days. Signs of loose pins should be reported to your doctor (for example, pain, clicking sounds, or any movement of the pins).

Skeletal traction

Displaced injuries (a fracture where the cervical spine is not aligned correctly) may need to be corrected by applying skeletal traction. Gentle traction is applied via a hoop connection that is attached to the Halo ring. A rope and weight bag riding over a pulley system behind the head of the bed is attached. This form of traction helps to ease the cervical spine back into the correct position.

Halo ring and vest

A lightweight sheepskin-lined plastic vest is attached to the ring by using 2 metal rods on each side, with a connecting bar on either side. Application takes about one hour.

Post application care

• Following application another X-ray is done to ensure the spine is in the correct position and stable before being able to move around.
• A Philadelphia collar is needed at all times and should be applied immediately if the ring becomes displaced, moves or comes off.
• Contact medical staff urgently is you feel any sudden neck pain, numbness or weakness in your arms.
• Allowance and adjustment needs to be made to compensate for the extra weight at the top of the body.
• Avoid bending at the waist as this may unbalance you and put pressure on the front skull pins.
• Skull pin sites may be painful at first but this should subside. Tell medical staff about any ongoing pain, noise or movement of the skull pins.
• Check the pin sites daily for signs of infection/redness or discharge. Clean with normal saline or tap water daily until sealed.
• Maintain normal weight as the vest is fitted to accommodate your current size. A well balanced diet will help with healing.
• Turn onto your side and push up with your arms to get out of bed and reverse procedure for getting back into bed.
• Avoid getting the sheepskin lining wet, but, should this happen, use a hair dryer on a low heat to dry it.
• An Allen key is to be kept attached to the vest at all times. All bolts need to be tightened regularly as they tend to get loose.
• Teach family and friends how to remove the vest in an emergency (for CPR). Undo the side clips and pull the flap up to the red line.
• When the ring and vest are ready to be removed medical staff will unscrew the skull pins using a torque screwdriver and remove the vest, usually in an outpatient clinic.

Where to get help

• Contact the hospital or health facility where you were fitted for your Halo ring and vest.
• See your doctor.
• Visit a GP after hours.
• Ring healthdirect Australia on 1800 022 222

Acknowledgements
Royal Perth Hospital

This publication is provided for education and information purposes only. It is not a substitute for professional medical care. Information about a therapy, service, product or treatment does not imply endorsement and is not intended to replace advice from your healthcare professional. Readers should note that over time currency and completeness of the information may change. All users should seek advice from a qualified healthcare professional for a diagnosis and answers to their medical questions.