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Thread: Halo vs. Fusion

  1. #1
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    Halo vs. Fusion

    I was so glad to find this site! Two weeks ago my mom (71 years young) fell and shattered (the doctor's description) her C2. Thankfully she is alive quickly regained breathing and now even has some mobility in her arms and hands. Originally they were going to place small srews in her C2 to stabilize the fracture. She developed pneumonia while laying in the hospital so this past monday and they placed her in a Halo instead (since she couldn't handle general anethesia with bad lungs). Once she is stronger again they have said fusion may be an option but she would likely never be able to turn her neck again. Anyone have any thoughts about the benfits of the halo for 3 months vs. fusion? Thanks so much!

  2. #2
    I just recently did a paper on treatment of SCI in the elderly, and there is significant evidence that they actually do better with surgical stabilization than with immobilization devices such as halos. Of course the issue of medical clearance for surgery with "bad lungs" has to be taken into consideration.

    I would recommend getting another opinion, ideally from a neurosurgeon who works with a lot of SCI patients and is familiar with the studies on SCI in the elderly.

    (KLD)

  3. #3
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    Would it be possible to get a copy of the paper or any other research on this topic?
    My mom also has severe osteoporosis due to 20+ years of prednisone use so her bones are in horrid shape. So if any of the research touches on that topic by any chance it would be SO helpful!

  4. #4
    It was a platform presentation (not a written paper). I will send you a PM of the references though.

    (KLD)

  5. #5
    This is a tough situation. I definitely agree with KLD that you need to get a 2nd opinion. Lungs can improve/change quickly, and you want them to know that you want to be aggressive about her care. Don't let them decide that they should be conservative with her treatment "just" because she's 71 years young! Get the best neurosurgeon with expertise in spine/trauma lined up as soon as you can. Keep reminding them about how healthy/active your mom was before her injury. Fight for her.

    In light of your mom's osteoporosis, I also wonder how it might interact with your fracture healing. If possible, ask if there is an endocrinologist with expertise in bone metabolism who can give input as to whether it is appropriate to put her on forteo (starting as soon as possible) during this critical year of bone healing, if there is not a contraindication. Eventually, she will have a fusion, and you want to make sure it takes well, and that she gets out of the halo sooner rather then later (as this will limit her rehab). Forteo has been shown not only to increase bone density, but increase the rate of fracture healing. I assume that she is on fosamax or one of the other bisphosphonates already, and these may not help as much. It is also important to be thinking about osteoporosis now, since your mom is already severely affected and spinal cord injury will unfortunately cause a progression of her osteoporosis. And this additional bone loss happens fast... within the first weeks/months. And again - you don't want her osteoporosis to worsen so that it will limit her physical therapy options.
    This would be a very aggressive treatment course, and some of the health care providers may disagree with me recommending this. BUT your mom is not the typical spinal cord injury..... she already has terrible osteoporosis so you should be pro-active because it will only get worse. So ask for consult from an appropriate doctor.

  6. #6
    Never able to turn her neck again ? Hmm..

    I was in a halo for three months, which I believe is pretty standard for the kind of C1 fracture I had. My C5-T1 was also fused (anterior plate, posterior rod). I happen to know that my doc also treated someone who broke her C2, and she also was in a halo for about that long, plus had a fusion between C2-C3. That's about how much knowledge of neurosurgery I have

    While one is in a halo you cannot turn your neck - you have to turn your whole torso. It's kind of a splint for the neck, as it were. Once the halo was taken off I was put in a soft collar for a couple of weeks and my PT had me doing neck exercises to work on strengthening the muscles and range of motion. The range is not what it was before the accident, but still pretty decent, and for the most part I've found ways to adapt.

    Curious what they said about her lungs .. another thing about being in a halo is that because the lower part is a vest tightly fitted about the chest, you physically can't take in as much air -- the little plastic breathing exerciser they gave me in the ICU was the children's version, because of the halo.

    Hope this helps, and best wishes to your mom !

  7. #7
    Quote Originally Posted by ThankfulDaughter View Post
    I was so glad to find this site! Two weeks ago my mom (71 years young) fell and shattered (the doctor's description) her C2. Thankfully she is alive quickly regained breathing and now even has some mobility in her arms and hands. Originally they were going to place small srews in her C2 to stabilize the fracture. She developed pneumonia while laying in the hospital so this past monday and they placed her in a Halo instead (since she couldn't handle general anethesia with bad lungs). Once she is stronger again they have said fusion may be an option but she would likely never be able to turn her neck again. Anyone have any thoughts about the benfits of the halo for 3 months vs. fusion? Thanks so much!
    TD,

    A C2 fracture is not an easy area to fuse. In fact, it is one of the more difficult areas to reach (as you might imagine) from the front. Many surgeons operate through the mouth (i.e. transoral approach) to reach C1 and C2. If C2 is indeed shattered, it may require a frontal approach. Fusion to the occiput may also be necessary.

    Operating on somebody who has pneumonia is very risky. I would agree with the decision to hold her with a halo until her lungs are in better shape and she is well controlled with antibiotics. Please do not be afraid of a fusion to the occiput. Yes, your mother will have restrictions of her neck movement but I don't think that there are many options.

    The most important priority is to stabilize her spine and her spinal cord be allowed to recover as much as possible. If she has an incomplete injury (which is very typical for a C1/C2 injury), she is likely to recover quite a lot of function.

    If she were my mother, I would probably want to have her fused as soon as possible so that she could start rehabilitation. The longer she lies in bed in a halo, the more likely she will develop some complication.

    Wise.

  8. #8
    I'm ignorant of why being in a halo would delay rehab. I was admitted to rehab at SCVMC about a week after my second neurosurgery (posterior instrumentation). I was in a halo the whole time I was there - they had me rolling around in a manual wheelchair, in a standing frame, on the parallel bars, lifting weights, using a walker, forearm crutches, etc.

    When I was discharged I was still in a halo, for about 6 weeks afterwards. I was going on daily walks around the neighborhood, even taking the bus to a nearby gym. I could not drive, of course.

    There are risks with being active in a halo, of course. The thing has four sharp titanium pins which go through the skin, into your skull. If you should fall and hit your head on the thing, the pin(s) could be driven into your brain (something the nursing staff was rather paranoid about).



    I even persuaded a friend to take me on a short hike about a week after getting out of the hospital



    I'm not sure this is recommended though

  9. #9
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    Thanks everyone for your replies and sharing your knowledge!! It has been so very helpful..and encouraging. My mom was actually able to walk the length of the parallel bars yesterday! She seems to be making a bit of progress every day and remains in pretty good spirits considering. So I truly am one thankful daughter

  10. #10
    WOW!

    Congratulations to you and your mom.
    She is obviously doing incredibly well. Thanks for the update.

    Yeah!

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