Halo-Vesting in Preschool Aged Children with Synchondrosis Fracture: A Case Series which Explores the Current Techniques Associated with this Procedure
Upper cervical spine injuries are the most common form
of spinal cord trauma that occur in preschool children.
Among such injuries, odontoid synchondrosis fractures are the most frequently
observed, though relatively few cases have been reported in the medical literature.
The most appropriate approach to describe such cases is physeal injuries of the basilar synchondrosis
plate between the odontoid process and the body of the axis. Acute odontoid synchondrosis
fractures are further classified into 3 subtypes based on the amount of dense displacement and
the degree of fracture angulation.
Type Ic, the most severe subtype, will require a posterior atlantoaxial fixation
for an associated atlantoaxial subluxation. The majority of Type Ia and type
Ib odontoid synchondrosis fractures that display only mild to moderate dense displacement
and angulation, can be adequately addressed through proper fusion.
While Minerva orthosis has been effective in the treatment for
two case series and a few case reports, the use of Halo-vesting in young
children presents challenges due to decreased skull thickness and the presence
of a certain amount of soft osseous tissue.
For these reasons, a certain level of controversy exists in the medical literature
as to whether the use of such a device is warranted. According to the opponents of this practice,
Halo-vesting is often a frustrating and anxiety-provoking experience for young patients.
Conversely, proponents believe that Halo-vesting is a well-tolerated procedure
in a majority of children as well as in toddlers.
Orthop Res Traumatol Open J. 2017; 2(1): 40-49. doi: 10.17140/ORTOJ-2-110
