Halo 

Background 

• Fix skull to torso 
• Good for rotational control 
  • Where does this happen?  
    • axial 
• Worst for lateral control 
  • Where does this happen 
    • subaxial 

Indications 

• axial 
• Subaxial trauma 
• Failed non op Atlanto Axial Rotatory Instability 
• Preop reduction spinal deformity 

Contraindications 

• Absolute 
  • Cranial fracture 
  • Infection 
  • Severe soft tissue 
• Relative 
  • Elderly 
    • 21% mortality in age 79+ 
      • Aspiration pneumonia 

Preop Imaging 

• CT 
  • Fractures? 
  • Children <10; bone thickness 

Adult Technique 

• Location 
  • Below equator 
  • 2 anterior 
    • 1cm above lateral 1/3 of eyebrow 
    • Lateral is in temporalis fossa 
    • Medial is supraorbital nervee 
  • 2 posterior 
• Torque – 8 inch pounds 

Pediatric Technique 

• CT preop to determine suture lines 
• Location 
  • Below equator 
  • 3-4 anterior 
    • 1cm above lateral 1/3 of eyebrow 
    • Lateral is in temporalis fossa 
    • Medial is supraorbital nerve 
      • Even medial to that is supratrochlear nerve 
  • 3-4 posterior 
• Torque – 2-4 inch pounds 

Complications 

• Pediatric > adult 
• Loosening 36% 
• Infection 20% 
  • Loose – remove pin 
  • Not loose – oral antibiotics 
• Discomfort 18% 
• Dural puncture 1% 
• Abducens Nerve CN6 palsy 
  • Lateral gaze lost 
  • Diplopia