Session VII - Spine

Complications of Halo Vest Management for Cervical Fractures in the Elderly

Lisa A. Taitsman, MD, MPH; Andrew C. Hecht, MD; Frank X. Pedlow, Jr., MD, Massachusetts General Hospital, Boston, MA

Purpose: Cervical spine fractures are a relatively common occurrence in the elderly. The choice of treatment is determined by the classification of the fracture and by the needs of the patient. Several authors have commented on the increasing rates of morbidity and mortality experienced by elderly patients with cervical fractures and, in particular, those managed with halo vests, although few studies have provided data to support these statements. This review details the specific complications encountered in halo immobilization of cervical spine fractures of patients 65 years of age or older.

Methods: A retrospective review was performed of records from two level-one trauma centers. A total of 940 patients who sustained cervical spine fractures between January 1990 and January 2000 were identified with use of ICD-9 codes as primary or secondary diagnoses. Seventy-five patients were 65 years of age or older and were treated in a halo vest. Classification of fractures, documented method of treatment and complications were ascertained from hospital records. Follow-up included hospital chart and limited outpatient chart review.

Results: The average age of the patients was 76 years; 40 (53%) were men and 35 (47%) were women. Twenty-three patients (31%) were involved in a motor vehicle collision, 46 (61%) had a fall, 28 (37%) tripped, and 17 (23%) fell down the stairs. Forty-one patients (55%) experienced at least one complication; 22 patients (29%) experienced pin problems, primarily loose or infected pins. Seventeen patients (23%) developed pneumonia, and 13 patients experienced respiratory compromise or arrests necessitating intubation, and/or tracheostomy and intensive care management. Due to aspiration, eight patients (11%) had feeding tubes placed. Other complications included confusion, gastrointestinal bleeding, cholecystitis, seizure, and urinary tract infections. All deaths were related to respiratory compromise, and six patients (8%) died while in the hospital. This number does not include several multitrauma patients who died from other causes or five patients who had cervical spinal fractures and were urgently intubated in the field or the emergency room.

Conclusions: Treatment of cervical spine fractures poses a particularly difficult problem in the elderly population, and we observed a broad range of complications. This is not to imply that halos are inappropriate devices for use in the elderly. It is important to recognize their potential dangers in order to enhance patient selection and emphasize the need to inform patients and their families of possible outcomes. While some of these complications are merely temporary setbacks, they are still of importance and warrant careful consideration.