Many cervical spine injuries do not require surgical treatment or cannot be taken for surgical treatment because of one reason or other. These cervical spine injuries are managed by non operative means of treatment.
The basic nonoperative options consist of bracing, skeletal traction in recumbent position and halo vest. These treatment modalities can be used either separately or in conjunction with one another.
The treatment needs to be monitored at regular intervals by radiographs.
The duration of application of an external immobilization device usually ranges from 2 to 4 months, and depends on the type of injury and the age of the patient.
External immobilization is also used for the adjuvant postoperative management of patients having undergone surgical stabilization of the cervical spine.
Bracing
Bracing of the neck can be performed with soft neck collar, rigid collars such as a Philadelphia or Miami-J device or cervicothoracic devices such as a Minerva or sternal occipital mandibular immobilization brace.
These devices do not help or in fracture reduction in the early postinjury phase. In the presence of minimally or nondisplaced fractures of the upper cervical spine, such as of the occipital condyle, atlas, or the vertebral body or neural arch of the axis, external bracing alone can be considered
Halo Orthosis
Halo ring and vest applications offer the most stable form of external immobilization of the upper cervical spine. In contrast to bracing, a halo vest assembly allows for some fracture manipulation and correction of malreduction. If a halo vest assembly is correctly placed, neck motion can be expected to be limited to quite an extent.
A halo can also be used for temporary reduction of distractive cervical spine injuries.
The halo does not effectively immobilize a profound ligamentous injury, such as a dislocation.
Because a halo relies on a close vest to torso fit, it may adversely affect pulmonary function. Therefore Halo is poorly tolerated by elderly patients and those with ankylosing spondylitis or trunk deformity
Halo is recommended for patients with isolated occipital condyle fracture, unstable atlas ring fracture, odontoid fracture, and displaced neural arch fracture of the axis.
Skeletal Traction
Traction can be used either for fracture reduction or to maintain spinal alignment till consolidation of the fracture is achieved prior to mobilizing the patient into the upright position with a halo or rigid brace.
The duration of the traction varies from few days to few months depending upon treatment strategy. This treatment requires nursing care, physiotherapy and back care.
However, this treatment is frequently associated with problems of recumbency which include chest infection and bed sores among others.
The current trend is more towards operative management which facilitate early mobilization.
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