The Journal of Bone and Joint Surgery, Vol 75, Issue 7 996-1003, Copyright © 1993 by Journal of Bone and Joint Surgery, Inc
The halo-Ilizarov distraction cast for correction of cervical deformity. Report of six cases
GP Graziano, JE Herzenberg and RN Hensinger
Section of Orthopaedic Surgery, University of Michigan Hospitals, Ann Arbor 48109.
Six patients were managed with gradual reduction of a deformity of the
cervical spine, before operative stabilization, with use of a modified halo
cast with adjustable distraction components that allowed the patient to sit
and walk while the deformity was being corrected. The distraction
components were constructed from the distractors, hinges, and connectors of
an Ilizarov apparatus. The diagnoses were atlanto-axial subluxation
secondary to rheumatoid arthritis, atlanto-axial rotatory subluxation
secondary to juvenile rheumatoid arthritis, post-traumatic atlanto-axial
rotatory subluxation, ankylosing spondylitis with an angulated fracture of
the seventh cervical vertebra, atlanto-occipital and atlanto-axial
subluxation secondary to familial cervical dysplasia, and cervicothoracic
kyphosis secondary to laminectomy and radiation for astrocytoma. All of the
deformities were corrected initially, but the deformity partially recurred
in three patients: in the lower cervical area because of pseudarthrosis in
one, and between the occiput and the first cervical vertebra after
arthrodesis between the first and second cervical vertebrae in two.
Complications included an infection at the site of the halo pin, which led
to replacement of the pin (one patient); pressure sores under the body cast
(two patients); dislodgment of the halo secondary to a fall, which
necessitated reapplication of the halo (one patient); and pneumonia (one
patient). Spinal distraction with halo-cast traction is a useful adjunct in
the treatment of selected complex cervical and high thoracic deformities.
Gradual three-dimensional correction may be obtained in a controlled
fashion, while the patient is allowed out of bed to sit and walk.
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