The halo-Ilizarov distraction cast for correction of cervical deformity. Report of six cases.

Six patients were managed with gradual reduction of a deformity of the cervical spine, before operative stabilization, with use of a modified halo cast with adjustable distraction components that allowed the patient to sit and walk while the deformity was being corrected. The distraction components were constructed from the distractors, hinges, and connectors of an Ilizarov apparatus. The diagnoses were atlanto-axial subluxation secondary to rheumatoid arthritis, atlanto-axial rotatory subluxation secondary to juvenile rheumatoid arthritis, post-traumatic atlanto-axial rotatory subluxation, ankylosing spondylitis with an angulated fracture of the seventh cervical vertebra, atlanto-occipital and atlanto-axial subluxation secondary to familial cervical dysplasia, and cervicothoracic kyphosis secondary to laminectomy and radiation for astrocytoma. All of the deformities were corrected initially, but the deformity partially recurred in three patients: in the lower cervical area because of pseudarthrosis in one, and between the occiput and the first cervical vertebra after arthrodesis between the first and second cervical vertebrae in two. Complications included an infection at the site of the halo pin, which led to replacement of the pin (one patient); pressure sores under the body cast (two patients); dislodgment of the halo secondary to a fall, which necessitated reapplication of the halo (one patient); and pneumonia (one patient). Spinal distraction with halo-cast traction is a useful adjunct in the treatment of selected complex cervical and high thoracic deformities. Gradual three-dimensional correction may be obtained in a controlled fashion, while the patient is allowed out of bed to sit and walk.