Clinical outcomes of elderly patients treated with halo vest immobilization.

Introduction: There is a lack of consensus on the efficacy and safety of halo vest immobilization (HVI) in elderly patients. The objective of this study was to evaluate HVI's impact on outcomes in patients 60 years or older with cervical spine fractures. Methods: This was a retrospective study of patients 60 years or older who underwent HVI for treatment of cervical spine fractures between January 2003 and March 2024 at a single institution. Key features of clinical presentation, outcomes at final follow-up, complications, and 1-year mortality rates were recorded. Results: A total of 54 patients were included for analysis. The average time spent in a halo vest was 2.69 (0.58) months, and the average time to final follow-up was 5.49 (5.84) months. The most common fracture morphologies were the Hangman variant (29.6%) and type III odontoid (29.6%). Forty-nine patients (94.2%) out of 52 patients considered were successfully treated as defined by the lack of need for surgical intervention. Three patients (5.6%) experienced medical complications; two of the three patients died within 30 days of HVI. Lastly, 18 patients (33.3%) experienced HVI instrumentation-related complications, the most common of which was loose halo pins (13.0%). Conclusion: HVI is associated with lower morbidity and mortality in elderly patients than previously reported and thus may be safely used in this population. However, providers should be mindful of initial clinical presentation and underlying comorbidities when weighing between surgical and nonsurgical intervention.