Application of halo, including removal; cranial
CPT4 code
Name of the Procedure:
Application of Halo, including Removal; Cranial
Common name: Halo traction, Halo fixator application
Summary
In layman's terms, the application of a halo is a procedure where a ring (the halo) is fixed to the skull with pins or screws, then connected to a vest or other external brace to stabilize the neck and head. This helps in aligning and stabilizing the cervical spine post-injury or surgery.
Purpose
This procedure is used to treat cervical spine injuries, spinal fractures, or severe neck instability. The goal is to immobilize the neck, allowing bones and ligaments to heal correctly and preventing further injury.
Indications
- Cervical spine fractures
- Severe neck instability due to ligament injury or degenerative conditions
- Pre- and post-operative stabilization of the cervical spine
- Certain congenital spinal deformities
Preparation
- Fasting several hours before the procedure if anesthesia is used
- Adjustments in medications as advised by the doctor
- Evaluation with imaging tests like X-rays or MRIs to assess the spine condition
Procedure Description
- The patient is positioned, often lying down or slightly reclined.
- Local anesthesia is applied to the spots where the pins or screws will be inserted.
- A halo ring is positioned around the patient's head, and pins are carefully inserted into the skull to secure the ring.
- The halo ring is then attached to a vest or brace to immobilize the head and neck.
- Adjustments are made to ensure proper alignment and comfort.
- The removal process involves the careful loosening and removal of the pins and the halo brace.
Duration
The application typically takes about 1 to 2 hours, depending on the complexity, with a similar or shorter duration for removal.
Setting
The procedure is generally performed in a hospital's operating room or a specialized outpatient surgical center.
Personnel
- Orthopedic or neurosurgeon
- Nurses
- Anesthesiologist, if general anesthesia is used
- Radiologic technologist for imaging guidance
Risks and Complications
- Infection at pin sites
- Pin loosening or migration
- Pressure sores from the vest
- Nerve injury or more severe complications, though rare
- Discomfort or headaches
Benefits
- Effective stabilization of cervical spine
- Promotes proper healing of bones and ligaments
- Prevents further spinal cord damage
- Enables patients to remain mobile to some extent while healing
Recovery
- Regular cleaning and care of pin sites to prevent infection
- Wearing the halo device for several weeks to months, as directed by the doctor
- Periodic follow-ups for adjustments and monitoring
- Gradual increases in activity under guidance, with eventual removal of the device
Alternatives
- Non-surgical braces or collars, though they may not provide as rigid immobilization
- Surgical fixation, which can be more invasive and may require a longer recovery
- Physical therapy and close observation without direct immobilization in milder cases
Patient Experience
During the application, discomfort from the pressure of the pins is common despite anesthesia. After the procedure, patients may experience discomfort, headaches, and limited mobility. Pain management and comfort measures, such as padding and frequent repositioning, help alleviate these issues. Follow-up care ensures proper healing and adjustment.