Lerman Non-Invasive Halo Introducing.. Lerman Non-Invasive Halo

Lerman Non-Invasive Halo ( NIH ) Designed to address and overcome to complications associated with the use of the Traditional Invasive Halo

Lerman NIH Padded carbon composite chest plate 2 posts for attaching plate to Halo Facemask ( halo ) with Silicone padding Posterior occipital support Padded criss cross straps posteriorly Anterior and posterior view of the Lerman NIH

Traditional Invasive Cervical Halo ( CH ) Used since 1959 Regarded as ‘the’ standard for external stabilisation for injury to cervical spine Consists of a 4 pin skull fixation halo and vest Studies have shown that this system fails to immobilise the unstable cervical spine as much as originally thought There are a number of complications associated with this Invasive Halo Application of the traditional Invasive Cervical Halo ( CH ) is particularly traumatic for patients. Until recently, it has been considered the best way to immobilise the cervical spine following injury/fracture However, there have been reports that the CH cannot fully immobilise the cervical spine as originally thought. 25% of spinal cord occur after the initial injury. This can happen while being transported or during early treatment. Mueller and Mueller JPO 2005 There is a rare but real risk of further neurological damage to the patient while fitting the invasive CH. Sawers, Di Paolo, Rechtine The Spine Journal 2008

Complications associated with Traditional Invasive Halo Pin and Ring loosening – 36% - 60% of patients Pin Infection in 20% of cases Dysphagia – 4% Pressure Ulcers – 11% Facial scarring Skull and Dural penetration Rare but real risk of further neurological deficit during application Suitability of the noninvasive halo for cervical spine injuries: a retrospective analysis of outcomes. Sawers, DiPaolo, Rechtine, The Spinal Journal, 2009 In addition to those listed, higher mortality rates have been reported among the elderly treated with use of Invasive CH. Mueller and Mueller JPO 2005 Pain could also be considered as a complication but articles didn’t highlight this Pin and ring loosening would reduce efficacy of the CH for those being treated Reducing risk of infection is always important Dysphagia; This is difficulty swallowing. Pressure ulcers will increase scarring

Sawers, DiPaola, Rechtine Study Suitability of the noninvasive halo for cervical spine injuries: a retrospective analysis of outcomes. The Spinal Journal. 2009; 216 – 220. Sawers, DiPaola, Rechtine Most substantial study

Retrospective study 17 Patients. 8 Female: 9 Male All sustained cervical spine injury All fitted with NIH by Certified Orthotist at discretion of Consultant At least 6 months follow up data available on all Average age 52.5 years Time spent in NIH; 36 – 150 days - Average 79 days Types of fractures: C1-C2 lateral fracture; Rotary subluxation; facet fractures; hangman and odontoid fractures

Outcomes… Complications All fractures healed successfully and in allignment No additional loss of neurological function Most reported the orthosis as feeling comfortable and secure No-ones course of treatment reverted to use of an Invasive halo One patient had surgery prior to application Complications One Occipital Ulcer 2 Cases of non compliance. 1 due to Dementia Both loosening and removing orthosis It would be interesting to know which patient developed the occipital ulcer. Did the person who required surgery have other fractures or injuries that required surgery? Non compliance; If some one has demetia, it was noted that use of an invasive CH in this instance may be more dangerous. Invasive CHs are not tamper proof!

Comparisons... Lerman NIH 12% ( 2 )non compliance where patient loosened and / or removed NIH. No incidence of Infection No Dysphagia 6% ( 1 ) reported ulcer No scarring Invasive Halo Pin and Ring loosening – 36% - 60% of patients Pin Infection in 20% of cases Dysphagia – 4% Pressure Ulcers – 11% Facial scarring Skull and Dural penetration Suitability of the noninvasive halo for cervical spine injuries: a retrospective analysis of outcomes. Sawers, DiPaolo, Rechtine, The Spinal Journal, 2009 Complications documented in this study, associated with use of Lerman NIH, are much lower than those commonly associated with use of invasive CHs.

Other comparisons… Advantages Lerman NIH can be applied in supine position Anterior plate of Lerman NIH can be removed quickly if rapid access to thorax required Floating occipital pad reduces pressure over the occiput Costs associated with Lerman NIH 40% less the that of Invasive CH Disadvantages Lerman NIH can be loosened by the patient Male patients would have difficulty shaving May not suit obese patients with short chins Advantages far outweigh disadvantages! Anterior plate is easily removed in case of CPR Male patients should not shave as a beard acts as a natural barrier and reduces ulcers

Conclusion Clinical efficacy of the Lerman NIH has been demonstrated. Further studies are warranted Has potential to eliminate complications associated with use of traditional Invasive methods Cost effective – No theatre slot required And…..

Long hair not a problem!! Only for internal use!!