The clinical application of Halo vest for reduction and immobilization before surgery for cervical spine fracture-dislocation in patients with ankylosing spondylitis

English Keywords:Fracture and dislocation of cervical spine  Ankylosing spondylitis  Halo vest  Reduction  Surgery

English Abstract:

  【Abstract】 Objectives: To investigate the safety and efficacy of Halo vest for the reduction and immobilization before surgery for cervical spine fracture-dislocation in patients with ankylosing spondylitis(AS). Methods: We retrospectively analyzed the clinical data of 23 AS patients with cervical fracture and dislocation underwent surgery in our department from January 2012 to January 2019. There were 22 males and 1 female, with a mean age of 53.0±7.4 years, ranging 39-64 years. C2/3 fracture occured in 1 patient, C4/5 in 5, C5/6 in 13, C6/7 in 1, and oblique fracture through vertebrae in 3(oblique fracture through C4-5 in 2 and C5-6 in 1). The mean follow-up was 22.4±7.7 months(12-36 months). A halo vest was used in each patient to reduce and immobilize the fractured spinal column ends after admission or examination, until the operation was finished. Lateral cervical X-ray examinations were performed before and after immobilization to evaluate the reduction condition. Displacement at fracture sites and secondary neurologic deterioration were recorded before and during operation. Posterior and combined anterior/posterior surgery were performed. Operation time, blood loss and complications were all recorded. American Spinal Injury Association(ASIA) impairment scale was used in grading the patients before operation and at final follow-up to evaluate the recovery of neurologic function. Besides, the time to fusion was recorded. Results: 17 patients achieved closed anatomical reduction; four achieved successful reduction, and two had reduction failure who achieved anatomical reduction after a second reduction under general anesthesia before operation. No patient presented with re-dislocation in the fracture ends or secondary neurologic deterioration during Halo vest immobilization. Eight patients underwent posterior approach alone surgery and 15 underwent one-stage combined anterior/posterior approach surgery. The operation duration was 203.3±68.6min(90-375min) and blood loss was 275±88.9ml(120-410ml). One ASIA grade A patient died 3 weeks after operation because of severe pneumonia and respiratory failure. One patient occurred incision infection 5d after operation and was cured after debridement and anti-inflammatory treatment, and no other severe complications occurred. At final follow-up, one ASIA grade B patient improved to C, 3 out of 5 grade C patients improved to D, and 13 out of 16 grade D patients improved to E. Although the others had no change in ASIA gradings, their muscle strengths were improved. The fractured vertebrae of all the patients achieved bony fusion within 12 months after operation. No patient presented with displacement, rupture or loosening of implants. Conclusions: The use of a halo vest before operation is safe and effective in AS patients with cervical fracture-dislocation, which is helpful for intraoperative reduction and simplifing the surgery and therefore improve the safety of operation.