Cervical Spine Implants

The cervical spine is unique from the rest of the vertebral column due to the common use of halo fixation. A halo is simply a ring external fixator that is rigidly attached to the outer skull table with pins. Usually, four rods are used to connect this ring to a well-molded plastic or plaster body jacket. The halo limits the motion of the cervical spine, allowing fractures to heal or arthrodesis to unite.

The most common cervical implant is a posterior cerclage wire (Fig... . 2Z2z13), which limits motion between adjacent vertebrae while fusion occurs. A bone block taken from the iliac crest is often used as a biologic implant in the anterior cervical spine to gain fusion. Special plates and screws have been developed for the anterior cervical spine. Their use is likely to accelerate in the future.

FIG. 272-13. This patient underwent posterior fusion of the entire cervical spine, with internal cerclage fixation supplemented by an external halo for 6 months.

COMPLICATIONS As with other external fixators, the most common complication of halo fixation is pin-tract infection. Infected pins are usually removed and a new pin placed in an alternative site. Loose, noninfected pins should never be tightened because this risks penetration of the inner skull table and resultant meningitis. The internal implants will fail if the vertebrae fail to unite.

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