Halo Placement Anatomical Considerations - Everything You Need To Know - Dr. Nabil Ebraheim

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Dr. Ebraheim’s educational animated video describes the anatomical considerations and application of the halo cervical orthosis.

The important points associated with halo placement will be highlighted.
The supratrochlear nerve exits the skull at the level of the frontal sinus. The location of this nerve is medial to the supraorbital nerve.
1.Determine ring or crown size (hold right overhead, visualize proper fit).
2.Determine vest side (from chest circumference measurement).
3.Keep patient awake or lightly sedated. Identify pin site locations and shave hair at posterior pin site.
4.Disinfect sites of pin placement and administer local anesthesia.
5.Keep tools needed for halo application beside you.
6.Place the halo ring just below the equator of the head to prevent cephalic migration of the halo. Before application of the screws, have the patient gently close eyes.
7.Apply the pins perpendicular to the outer table and tighten pins at 2 inch/lb increments in a diagonal fashion.
8.Apply posterior and anterior portions of the halo vest and connect uprights to halo ring. An experienced individual should hold the head while applying the vest to prevent any flexion or extensions of the neck. Recheck the fittings, screws, and nuts!
The halo provides better immobilization for the upper cervical spine than the lower cervical spine. 31% of the normal motion may be obtained in a halo. Two anterior pins are placed 1 cm above the orbital line, over the lateral two-thirds of the orbit and below the level of the greatest circumference of the skull. If the anterior pins are placed more medially, then there is a greater risk of injury to the supra-orbital nerve and the supratrochlear nerve. If the pins are placed more laterally, then there is a risk of injury to the temporalis muscle. Two posterior pins are placed about 1 inch above the pinna of the ear. One anterior pin is first tightened then the diagonal posterior pin is tightened next. The remaining two pins are then tightened in this order. Use a torque screw driver to tighten the pins with tension ranging from 6-8 inch/lbs. tension of 10 inch/lbs may pass through the outer table. Post application x-ray must be obtained to ensure adequate placement of the pins. Attach vest removal tools to the vest with tape or keep these tools near the patient in the event that urgent removal of the vest is needed.
Pin Care: pins should be checked every 48 hours to make sure that they are tightened to 8 inch/lbs. of torque in adults and 4 inch/lbs in pediatric patients. In adults: 4 pins – 8 inch/lbs. In pediatrics: 8 pins-4 inch/lbs. The pins should be cleaned with a hydrogen peroxide sterile swab every other day. Halo is good for the cervical spine, but it is not good for distractive forces. It may be contraindicated.

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