Pediatric Halo Use: Indications, Application, and Potential Complications.

A halo has many applications for the treatment of pediatric spine pathology. It is most commonly used with gravity traction for the correction of severe thoracolumbar deformity over the course of several weeks before a staged fusion or growing implant placement. It is also used for preoperative optimization, secure positioning of small skulls for prone spine approach, cervical deformities such as basilar invagination, trauma treatment, or postoperative immobilization with a halo vest. Application of a halo is generally straightforward, but surgeons must be vigilant about complications and risks. Key Concepts: (1)Halo placement must be done with an understanding of safe corridors for pin placement and pin torque specific to a patient's bony anatomy, quality, and age.(2)In severe thoracolumbar spinal deformity, halo-gravity traction (HGT) allows for elongation of the spine, correction of deformity, and chest elongation before the second-stage placement of implants.(3)In the cervical spine; HGT can be used to reduce basilar invagination before occipitocervical fusion, C1-2 rotatory subluxation before C1-2 fusion. A halo vest orthosis can be a definitive treatment for atlanto-occipital dislocation without neurologic injury.(4)Complications such as pin site infections and nerve palsies are frequent but most resolve quickly with appropriate management and vigilant monitoring.