Non-operative management of acute upper cervical injuries.

The results of a closed, non-operative type of treatment in acute upper cervical injury have been reviewed, especially as they relate to the use of the halo cast or vest. The morbidity with the use of this device has been minimal and there has been no mortality. Early patient mobilization has been readily achieved and in the case of the Hangman's, Jefferson's, and odontoid fractures, stable solid bony healing has been achieved in nearly all cases. Similar results have been noted in the C-1 arch fracture, as well as the acute post-infectious subluxations of C-1/C-2. In a small number of cases involving traumatic C-1/C-2 and occipital/atlas subluxation, there has occurred a significant incidence of instability, despite adequate closed treatment. This has been likely to be due to the serious ligamentous disruption in these cases and it would appear that surgical fusion may be the preferential form of initial treatment in this group of injuries.