CRCM  Vol.2 No.9 , December 2013
Brain abscess from halo pin penetration
ABSTRACT

Halo fixation devices are often employed for critically ill or trauma patients with unstable cervical pathologies. These include fractures, spinal decompression and reconstruction procedures. However, the critical care literature has surprisingly little information in regard to associated complications. Perry and Nickel pioneered the initial halo device in 1959 and soon afterward recognized complications associated with its use [1]. They developed a detailed regimen to prevent abnormal pin placement and infections. The details include pin placement in “safe” zones, specific degrees of torque, and techniques to minimize infection risk. Despite a low death rate, a cerebral brain abscess often leads to prolonged neurological morbidity [2]. Seizures and pneumocranium have also been ascribed to intracranial penetration of halo pins [3,4]. The following describes a patient with cerebral abscess secondary to halo pin penetration. He then developed several other associated complications during hospitalization.

 


Cite this paper
Patel, R. , Desai, B. and Gallagher, T. (2013) Brain abscess from halo pin penetration. Case Reports in Clinical Medicine, 2, 505-507. doi: 10.4236/crcm.2013.29132.
References
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[2]   Ray, A., Iyer, R.V. and King, A.T. (2006) Cerebral abscess as a delayed complication of halo fixation. Acta Neurochirurgica (Wien), 148, 1015-1016.
http://dx.doi.org/10.1007/s00701-006-0799-0

[3]   Cheong, M.L., Chan, C.Y., Saw, L.B. and Kwan, M.K. (2009) Pneumocranium secondary to halo vest pin penetration through enlarged frontal sinus. European Spine Journal, 18, S269-S271.
http://dx.doi.org/10.1007/s00586-009-1004-y

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http://dx.doi.org/10.1007/s00586-008-0759-x

[6]   Garfin, S.R., Botte, M.J., Waters, R.L. and Nickel, V.L. (1986) Complications in the use of the halo fixation device. The Journal of Bone & Joint Surgery, 68A, 320-325.

[7]   Quinones-Hinojosa, A., Chi, J.H. and Manley, G.T. (2007) Emergent placement of halo orthosis after a traumatic cervical injury leading to a cerebral abscess. Journal of Trauma, 62, E11-E13.
http://dx.doi.org/10.1097/01.ta.0000246938.18656.5d

[8]   Saeed, M.U., Dacuycuy, M.A. and Kennedy, D.J. (2007) Halo pin insertion-associated brain abscess: Case report and review of literature. Spine, 32, E271-E274.
http://dx.doi.org/10.1097/01.brs.0000259976.46403.8a

[9]   Papgelopoulos, P.J., Sapkas, G.S., Kateros, K.T., Papdakis, S.A., et al. (2001) Halo pin intracranial penetration and epidural abscess in a patient with a previous cranioplasty: Case report and review of literature. Spine, 26, E463-E467. http://dx.doi.org/10.1097/00007632-200110010-00030

[10]   Rizzolo, S.J., Piazza, M.R., Cotler, J.M., et al. (1993) The effect of torque pressure on halo pin complication rates. Spine, 18, 2163-2166.
http://dx.doi.org/10.1097/00007632-199311000-00003

[11]   Pande, K., Basu, S. and Webb, J.K. (1998) Transient brain injury from penetration of the halo pin. Spinal Cord, 36, 732-733. http://dx.doi.org/10.1038/sj.sc.3100586

[12]   Olson, R.S. (1996) Halo skeletal traction pin site care: Toward developing a standard of care. Rehabilitation Nursing, 21, 243-246.

[13]   Victor, D.I., Breshan, M.J. and Keller, R.B. (1973) Brain abscess complicating the use of halo traction. The Journal of Bone & Joint Surgery, 53A, 635-639.

[14]   Rosenblum, D. and Ehrlich, V. (1995) Brain abscess and psychosis as a complication of a halo orthosis. Archives of Physical Medicine and Rehabilitation, 76, 865-867.

 
 
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