Halo vest immobilization

The halo vest is the most effective brace for restricting motion in the upper cervical spine. Although the indications for nonsurgical management with the halo vest are a topic of debate, the halo vest is frequently used to treat fractures such as Jefferson fractures, odontoid fractures, and hangman’s fractures. Conservative management with the halo vest may avoid the risk of surgery; however, it is not a completely benign intervention. The weight and constriction of the vest impair swallowing, pulmonary function, and mobility. The ability of the patient to tolerate immobilization with the halo vest is an important consideration before its application. One key to avoiding complications with the halo vest is to select an appropriate location for the halo pins. Structures that must be avoided include the frontal sinus, supraorbital nerve, and temporalis muscle. After application of the halo vest, careful clinical and radiographic follow-up should be conducted in all cases to ensure that the patient is tolerating the vest and that it is effective in restricting cervical motion.