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

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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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!

9. 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.

10. 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

11. 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…..

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