A New Non-Invasive Halo in Pediatric Cervical Spine Immobilization

Purpose: Over the last 7 years we have developed a non-invasive halo utilizing a breathable skin adhering interface to immobilize the pediatric cervical spine in an adjustable position.

Methods: The non-invasive halo immobilizes the head with breathable skin adhering pads, and is connected through a universal joint to an adjustable vest. Posterior cervical spine surgery can be performed with the noninvasive halo in place.

The non-invasive halo was used on 28 children (ages 1 to 16 years). In 13 of 28 children, the device provided successful immobilization of the cervical spine in an overcorrected position following release of the sternocleidomastoid muscle for congenital muscular torticollis release. In 2 children, gentle and safe reduction of longstanding C1-C2 rotatory subluxation was achieved. In 8 patients, post-operative immobilization was achieved for spinal fusions. In 1 patient, the immobilization with non-invasive halo was the treatment for cervical spine fracture.

Results: The non-invasive halo was successful in 25 of 28 patients with no complications and no scars. Two complications occurred in the two youngest children; both age 2, with facial swelling and intolerance of the pads against the face. These two failures occurred with an early version of the orthosis and have not occurred with the current version. The third complication was a in 10 year-old boy with anterior-posterior fusion of an unstable cervical spine following tumor resection. Movement of the anterior strut graft was recognized radiographically, but clinical outcome was not affected and successful. The non-invasive halo was used successfully as a salvage to replace a standard halo in one child with a severely infected pin site. Longstanding C1-C2 rotatory subluxations were safely reduced in 4 children with the non-invasive halo.

Conclusions: A non-invasive halo with a breathable skin adhering interface provides positioning and immobilization of the cervical spine safely and is well tolerated. Relative contraindications may include children very young children (<3 years) or children with an unstable spine. We found this device particularly useful in the gentle and safe reduction of longstanding C1-C2 rotatory subluxations, for post-operative immobilization overcorrected position following sternocleidomastoid release congenital muscular torticollis.