Houston Methodist. Leading Medicine

Neck FAQ

Question:

My 23-year-old daughter is living with me for a month while she gets used to wearing a halo vest for a cervical spine fracture. We are wracking our brains for ways to help her get more comfortable. The sheepskin lining the vest is supposed to make it more comfortable but she say its itchy. They showed us how to clean the screws and pins, but how do you take a bath or shower? Any tips you can offer would be a great help.

Answer:

Fractures of the upper cervical spine (C1-C2) can be stabilized without surgery by using a special apparatus called a halo vest. The vest is made of durable plastic that fits over the chest with a supportive collar around the neck. Four long, vertical metal rods attach the vest to a crown around the entire head. Metal screws hold the halo portion to the skull. The halo has a few problems of its own, but it eliminates the need for surgery with all its potential complications. The device is attached under local anesthesia. The patient's stay in the hospital is much shorter. The patient can get up and move about right away. The downside of a halo vest is the weight and of course, the fact that it cannot be removed. As intended, neck motion is not allowed while the fracture heals. Some say that is the blessing and the curse. Comfort and personal hygiene are important during the weeks and months the patient must wear the vest. Women may have a more difficult time adapting -- especially if they are large breasted. But there are some tricks that patients have shared over the years that we can pass along here. A T-shirt can be worn under the vest if it's not too tight or too bulky. Wrinkles must be smoothed out carefully. To get the T-shirt under the vest, you will have to cut along the top shoulder seam on one side. Your daughter will step into the shirt while you help her gently pull it up through the bottom of the halo. Once the shirt is all the way up, she can put her arm through the uncut sleeve and have you safety pin or tape the cut sleeve closed. The shirt can be worn for more than one day but should be exchanged for another T-shirt as needed. Bathing can be done carefully. Your daughter can sit in a bath with a small amount of water. Make sure you follow every precaution to prevent falls. Place a nonskid bath mat in the tub before getting in. Install safety bars to hold on to while getting in and out of the tub. You can purchase a thin flannel or silk material from a fabric store to make a wash cloth that can slide underneath the vest. Do NOT use soap unless approved by the physician. Soap residue and build-up from inadequate rinsing can cause skin problems. You can use a similar cloth to help dry the skin but follow-up with a blow dryer on the cool setting to get into difficult to reach areas. The biggest problem many people have is with infection at the pin insertion sites. It's important to follow the instructions provided at the clinic. You can put a little saline solution (available at any drug store) around the pin sites whenever there is any oozing or crusting. Gently cleanse from the pin site outward to remove any debris. Ask the nurse or doctor about applying moisturizer to the area and to the skin. They may have some guidelines for you and a specific recommendation on type of skin lotion to use. Avoiding infections will help minimize scarring once the halo device is removed. Dorothea Daentzer, MD, and Thilo Flörkemeier, MD. Conservative Treatment of Upper Cervical Spine Injuries with the Halo Vest: An Appropriate Option for All Patients Independent of Their Age? In Journal of Neurosurgery: Spine. June 2009. Vol. 10. No. 6. Pp. 543-550.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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