TY - JOUR
T1 - Acute stabilization of the cervical spine by halo/vest application facilitates evaluation and treatment of multiple trauma patients
AU - Heary, Robert F.
AU - Hunt, C. David
AU - Krieger, Abbott J.
AU - Antonio, Constance
AU - Livingston, David H.
PY - 1992/9
Y1 - 1992/9
N2 - The management of acute cervical spine injuries has traditionally used bed-based skeletal traction until all non-neurologic injuries have been evaluated. This treatment method substantially hinders the ability to transport patients and to perform imaging studies and surgical procedures. In contrast, early application of a halo/vest apparatus provides immediate cervical stabilization and facilitates the diagnostic work-up and treatment of the patients with multiple injuries. The records of all 78 patients admitted from February 1988 through June 1991 who had acute cervical spine fractures, subluxations, or both with a risk of instability were reviewed. All patients were treated with halo/vests and no patient deteriorated neurologically following halo/vest application. Twenty-nine patients (37%) had a total of 55 associated injuries including long bone/pelvic fractures in 17, thoracic injuries in 13, closed head injuries in 11, facial fractures in 6, noncontiguous spinal fractures in 5, and abdominal injuries in 3. The mean Injury Severity Score (ISS) was 18 (range, 9- 54). While in the halo/vest, 43 patients (55%) had a total of 99 diagnostic studies completed and 46 patients (59%) had a total of 76 surgical procedures performed. There were 35 neurosurgical procedures on 32 patients and 41 non-neurosurgical surgical procedures on 24 patients. Over the past year, 20 of 21 patients (95%) had their halo/vests placed in the emergency department. The data demonstrate that many diagnostic and surgical procedures need to be performed on patients with unstable cervical spine injuries. While we recognize that application of the halo/vest is not the definitive treatment in a number of patients with multiple injuries (41% in this series), acute placement of the halo/vest both stabilized the patients’ neurologic status and facilitated the expeditious diagnosis and treatment of potentially life- threatening associated injuries.
AB - The management of acute cervical spine injuries has traditionally used bed-based skeletal traction until all non-neurologic injuries have been evaluated. This treatment method substantially hinders the ability to transport patients and to perform imaging studies and surgical procedures. In contrast, early application of a halo/vest apparatus provides immediate cervical stabilization and facilitates the diagnostic work-up and treatment of the patients with multiple injuries. The records of all 78 patients admitted from February 1988 through June 1991 who had acute cervical spine fractures, subluxations, or both with a risk of instability were reviewed. All patients were treated with halo/vests and no patient deteriorated neurologically following halo/vest application. Twenty-nine patients (37%) had a total of 55 associated injuries including long bone/pelvic fractures in 17, thoracic injuries in 13, closed head injuries in 11, facial fractures in 6, noncontiguous spinal fractures in 5, and abdominal injuries in 3. The mean Injury Severity Score (ISS) was 18 (range, 9- 54). While in the halo/vest, 43 patients (55%) had a total of 99 diagnostic studies completed and 46 patients (59%) had a total of 76 surgical procedures performed. There were 35 neurosurgical procedures on 32 patients and 41 non-neurosurgical surgical procedures on 24 patients. Over the past year, 20 of 21 patients (95%) had their halo/vests placed in the emergency department. The data demonstrate that many diagnostic and surgical procedures need to be performed on patients with unstable cervical spine injuries. While we recognize that application of the halo/vest is not the definitive treatment in a number of patients with multiple injuries (41% in this series), acute placement of the halo/vest both stabilized the patients’ neurologic status and facilitated the expeditious diagnosis and treatment of potentially life- threatening associated injuries.
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U2 - 10.1097/00005373-199209000-00019
DO - 10.1097/00005373-199209000-00019
M3 - Article
C2 - 1404517
AN - SCOPUS:0026727880
SN - 0022-5282
VL - 33
SP - 445
EP - 451
JO - Journal of Trauma - Injury, Infection and Critical Care
JF - Journal of Trauma - Injury, Infection and Critical Care
IS - 3
ER -