Lerman NonInvasive Halo NIH Designed to address and overcome to complications associated with the use of the Traditional Invasive Halo Lerman NIH Padded carbon composite ID: 806721
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Slide1
Introducing..
Lerman Non-Invasive Halo
Slide2Lerman 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 plateto HaloFacemask ( halo ) with Silicone padding
Posterior occipital support
Padded criss cross straps
posteriorly
Slide4Traditional Invasive Cervical Halo
( CH )
Used since 1959
Regarded as ‘the’ standard for external stabilisation for injury to cervical spineConsists of a 4 pin skull fixation halo and vestStudies 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
Slide5Complications 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
Slide6Study
Suitability of the noninvasive halo for cervical spine injuries: a retrospective analysis of outcomes.
The Spinal Journal. 2009; 216 – 220.
Sawers, DiPaola, Rechtine
Slide7Retrospective study
17 Patients. 8 Female: 9 Male
All sustained cervical spine injury
All fitted with NIH by Certified Orthotist at discretion of ConsultantAt least 6 months follow up data available on allAverage age 52.5 yearsTime spent in NIH; 36 – 150 days - Average 79 days
Types of fractures: C1-C2 lateral fracture; Rotary subluxation; facet fractures; hangman and odontoid fractures
Slide8Outcomes…
All fractures healed successfully and in allignment
No additional loss of neurological function
Most reported the orthosis as feeling comfortable and secureNo-ones course of treatment reverted to use of an Invasive haloOne patient had surgery prior to applicationComplications
One Occipital Ulcer
2 Cases of non compliance. 1 due to Dementia Both loosening and removing orthosis
Slide9Comparisons...
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 HaloPin and Ring loosening – 36% - 60% of patientsPin Infection in 20% of casesDysphagia – 4%Pressure Ulcers – 11%Facial scarringSkull and Dural penetration Suitability of the noninvasive halo for cervical spine injuries: a retrospective analysis of outcomes. Sawers, DiPaolo, Rechtine, The Spinal Journal, 2009
Slide10Other comparisons…
Advantages
Lerman NIH can be applied in supine position
Anterior plate of Lerman NIH can be removed quickly if rapid access to thorax requiredFloating occipital pad reduces pressure over the occiput Costs associated with Lerman NIH 40% less the that of Invasive CHDisadvantages
Lerman NIH can be loosened by the patient
Male patients would have difficulty shaving
May not suit obese patients with short chins
Slide11Conclusion
Clinical efficacy of the Lerman NIH has been demonstrated.
Further studies are warranted
Has potential to eliminate complications associated with use of traditional Invasive methodsCost effective – No theatre slot required And…..
Slide12Long hair not a problem!!