The Journal of Bone and Joint Surgery (American). 2009;91:71-79.
doi:10.2106/JBJS.G.01347
© 2009 The Journal of Bone and Joint Surgery, Inc.
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 Trauma Test 25: Spring 2009 (publication date May 15, 2009; expiration date...
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Incidence of and Risk Factors for Complications Associated with Halo-Vest Immobilization: A Prospective, Descriptive Cohort Study of 239 Patients

Joost J. van Middendorp, MD1, Willem-Bart M. Slooff, MD2, W. Ronald Nellestein2 and F. Cumhur Öner, MD, PhD2

1 Department of Orthopaedics, University Medical Center Nijmegen, Radboud University Nijmegen, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands. E-mail address: jvanmiddendorp{at}gmail.com
2 Departments of Orthopaedics (W.R.N. and F.C.O.) and Neurosurgery (W.-B.M.S.), University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands. E-mail address for W.-B.M. Slooff: w.b.m.slooff{at}umcutrecht.nl. E-mail address for W.R. Nellestein: w.r.nellestein{at}umcutrecht.nl. E-mail address for F.C. Öner: f.c.oner{at}umcutrecht.nl

Investigation performed at the Spine Unit of University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Background: Since high rates of serious complications, such as death and pneumonia, during halo-vest immobilization have been reported, there has been a tendency of restraint with regard to the use of the halo vest. However, the rate of complications in a high-volume center with sufficient experience is unknown. Our objective was to determine the incidence of and risk factors associated with complications during halo-vest immobilization.

Methods: During a five-year period, a prospective cohort study was performed in a single, level-I trauma center that was also a tertiary referral center for spinal disorders. Data from all patients undergoing halo-vest immobilization were collected prospectively, and every complication was recorded. The primary outcome was the presence or absence of complications. Univariate regression analysis and regression modeling were used to analyze the results.

Results: In 239 patients treated with halo-vest immobilization, twenty-six major, seventy-two intermediate, and 121 minor complications were observed. Fourteen patients (6%) died during the treatment, although only one death was related directly to the immobilization and three were possibly related directly to the immobilization. Twelve patients (5%) acquired pneumonia during halo-vest immobilization. Patients older than sixty-five years did not have an increased risk of pneumonia (p = 0.543) or halo vest-related mortality (p = 0.467). Halo vest-related complications ranged from three patients (1%) with incorrect initial placement of the halo vest to twenty-nine patients (12%) with a pin-site infection. Pin-site infection was significantly related to pin penetration through the outer table of the skull (odds ratio, 4.34; 95% confidence interval, 1.22 to 15.51; p = 0.024). In 164 trauma patients treated only with halo-vest immobilization, cervical fractures with facet joint involvement or dislocations were significantly related to radiographic loss of alignment during follow-up (odds ratio, 2.81; 95% confidence interval, 1.06 to 7.44; p = 0.031).

Conclusions: There are relatively low rates of mortality and pneumonia during halo-vest immobilization, and elderly patients do not have an increased risk of pneumonia or death related to halo-vest immobilization. Nevertheless, the total number of minor complications is substantial. This study confirms that awareness of and responsiveness to minor complications can prevent subsequent development of serious morbidities and perhaps reduce mortality.

Level of Evidence: Prognostic Level IV. See Instructions to Authors for a complete description of levels of evidence.


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