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Weakness in biting and chewing strength
8%
488/6292
Deficit in medial and downward eye movement
10%
610/6292
Deficit in lateral eye movement
60%
3762/6292
Inability to close eyes against resistance
20%
1228/6292
Tongue deviation toward the affected side
3%
165/6292
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Figures A and B depict a patient with an Type II odontoid fracture. Cranial nerve VI palsy is the most common nerve palsy associated with halo cervical traction. A cranial nerve VI palsy would result in paralysis of the lateral rectus, causing a deficit in lateral eye movement. The cranial nerves and functions are in Illustration A. Halo fixation is indicated for a number of conditions in the cervical spine including definitive treatment for fractures and preoperative reduction. In adults, four pins are placed at 6-8in/lbs. The safe zone is defined 1cm superior to the outer 2/3 of the orbit. Absolute contraindications include active infection, cranial fractures and severe soft-tissue injury at pin sites. Pin loosening is the most common complication in adults, followed by pin site infection. Wilkens et al investigated cranial nerve complications with halo immobilization and traction in 70 patients. They found the sixth cranial nerve was most commonly affected by distraction and resulted in weakness in lateral gaze. They emphasize that frequent monitoring of the patients in skeletal traction is necessary, and prompt recognition of the clinical signs of these complications must be stressed. Bono et al report halo immobilization can be used for the definitive treatment of cervical spine trauma, preoperative reduction in the patient with spinal deformity, and adjunctive postoperative stabilization following cervical spine surgery. They state skull fracture, infection, and severe soft-tissue injury at the pin sites as absolute contraindications. Relative contraindications include severe chest trauma, obesity, advanced age, and a barrel-shaped chest. Figure A shows a sagittal CT showing a Type II odontoid fracture with anterior displacement. Figure B is an axial CT at the level of the odontoid again showing anterior diplacement of the dens. Illustration A lists the cranial nerve. Illustration B & C illustrate how to place a halo fixator. Illustration D shows the safe zone for placement of your anterior halo pin.
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