A halo brace is an orthotic, or support, that helps immobilize and protect the bones in the neck (cervical spine) following an injury or surgery. The halo brace consists of a halo (ring), a body jacket (vest), and rigid uprights (rods).

The halo is a rigid ring, closed or opened in the back, which surrounds the head and is attached by pins. There can be anywhere from four to 10 pins, depending on the type of halo being used by your physician. The pins are threaded through the halo into the outer portion of the skull. Some halos are pinless, but they are used only in certain situations.

The vest is plastic and sometimes lined with sheepskin. The sheepskin lies against the patient’s body or torso. Rigid rods or “uprights” connect the halo to the vest.

There are many things you can do to prepare your home for your halo patient:

• Identify potential obstacles and tripping hazards, such as shifting rugs, bulky furniture and electrical cords. Remember that balance, center of gravity and coordination will be affected after the halo placement.
• Put away sports equipment, toys and other objects that require a lot of movement to operate, so that your child is not tempted to play with them.
• Consider using a hospital bed for your halo patient, depending on the layout of your home. This can be discussed with your doctor prior to halo placement.
• If possible, adjust the TV or seat to be level with the child’s head. Keep in mind that he or she won’t be able to sit low and look up.
• Keep any large family pets that have the potential to jump up on your child in another room or in an enclosed area away from the patient.

• Consider cutting your child’s hair prior to application of the halo. This will help prevent long hair from catching in the pins, which can complicate halo removal.
• Get ready for your child to be out of school for several months. Make arrangements with your child’s school and teacher to allow your child to do some schoolwork once they are feeling better.
• Some parents suggest getting your child used to wearing a bib prior to surgery so it does not become a struggle once the halo is on.

To prepare your other children for being around a sibling with a halo brace, show them pictures and let them ask questions. Find out if your hospital has a child life program. This type of program will work with children in your family to prepare them for the halo and to answer their questions.

To prepare adults in your family, show them pictures of halo braces or send them to this website. Remind your family and visitors to always wash their hands while in the house. Also, remind them that they will not be able to touch the halo or engage in certain play activities once your child comes home.

If your child travels in a car safety seat, make sure that the seat is high and wide enough to support a halo. If you don’t own a seat that is large enough, consider contacting a physical therapist, an occupational therapist or a nurse at your local hospital. They may be able to lend you a seat, work with you and a local safety organization to borrow a seat or help you with the proper alternatives, such as a harness.

Consider getting a stroller for your child for traveling in malls or through a large hospital. Strollers should have a firm back and be wide and high enough to support a halo. A wheelchair may be necessary for both inside and outside travel. This will be especially important in the first few weeks after surgery while your child regains strength. Wagons have also been helpful for many people.

Your surgeon will determine the amount of time your child will be in the halo based on X-rays. This can range from several weeks to several months. The type of surgery, individual health considerations and postoperative course all play a part in the length of time spent in a halo brace.

Once the doctor determines the need for a halo brace, the next step is the application. A halo brace is applied in a controlled setting, such as an operating room. Your child will be given an anesthetic for the procedure so that he/she won’t feel pain.

The X-rays used to determine the child’s need for a halo are reviewed in the operating room. They will be available to the doctor during the halo placement.

The halo stays steady with pins that are threaded through the ring and anchored to the head (unless the physician is using a pinless halo). The halo and its jacket and rods hold the head still, so that the bones can heal. The pins in the halo are secured to the skull, which prevents any motion in the neck. The pins are inserted using a special tool and then tightened securely.

The vest is fitted based on body size and attached to the halo with the supporting bars. In some cases, the vest will be premeasured or customized before the day of placement.

Your child may have pain at the pin sites or at the surgical incisions after waking up in the recovery room with the halo brace. Pain medication will be dispensed while your child is still in the hospital, based on the doctor’s orders and individual needs. Pills and liquid pain medication will also be provided at discharge. After a week or two, there should be a noticeable decrease in pain and in the need for pain medication. A halo should not hurt, and the vest should not rub. If this occurs, contact your health provider.

After surgery, you will be given a special screwdriver and wrench. They must be attached to the halo uprights at all times, as they will be used when removing the halo. In case of emergency, it is essential that these tools be available for the prompt removal of the halo.

Possible Complications for a Patient in a Halo:

• Pain
• Pin-site infections
• Pin loosening
• Social isolation
• Eating and sleep disturbances
• Loss of intervertebral alignment
• Forehead scarring
• Pin penetration into the head
• Pressure sores under the vest
• Headaches
• Pin penetration into the dura, causing a cerebrospinal fluid (CSF) leak
• Scarring once the skin has healed at the pin insertion site

Other risks are associated with spinal surgery or spinal cord injury:

• Numbness
• Tingling
• Pain
• Paralysis

It is important to speak with your doctor about potential complications and their treatment. Some problems can be avoided with proper postoperative care at home.

During postoperative visits, new X-rays will be taken to assist in measuring how much healing has taken place since the last visit. Your child’s surgeon will look at these X-rays during your office visit and discuss care plans with you and your family. These plans may change unexpectedly, but this should not be cause for alarm.

Typically, patients are awake during halo removal, which takes place in a clinic. First, the doctor loosens the nuts on the vest and removes the uprights. Then, the nuts on the halo ring are loosened and a screwdriver is used to loosen the pins while someone is holding the ring. Once all the pins are loosened, the ring is lifted from the head. Long hair may complicate halo removal.

There will be small wounds left from the pins. Sometimes they will have a slight amount of bloody fluid, which can be remedied by bandages. All the pin sites will scab over within 24 to 48 hours. Caring for these pin-site openings is easy because you no longer need to clean the pins. Scars will remain but should fade considerably.

Once the halo is removed, your child may need to wear a collar for some time, as recommended by the surgeon. While your child may be completely healed at this time, the collar offers additional protection from overusing the neck and serves as a transition to normal use. With a collar, as with the halo, checking for skin breakdown should remain part of the daily routine. The collar shouldn’t rub, burn or hurt.

Moving around in a halo can be difficult, especially for children with short stature. Some may need a walker. Others may not be able to be mobile due to the halo’s weight. Pain medication may also affect balance and physical strength. Comfort levels typically increase with changing positions from lying to standing and walking.

If your child is able, walking around the house should become part of the daily routine during the postoperative period, if allowed by your doctor. Safety is paramount to prevent falls and slips, especially while going up and down stairs and navigating uneven ground. Any obstacles around the house should be addressed.

It is a good idea to take time and move at a normal pace while wearing a halo. Any movement that causes pain or uneasiness should be avoided. Avoid bending forward to grab objects, such as items that have fallen to the floor; consider using an adaptive device to help reach and pick things up.

Precautions and activities may change based on healing and length of time in the halo. Some safe play ideas for children include:

• Filling a large plastic box with dried beans and cups and spoons (no sandboxes)
• Painting, drawing and coloring
• Fingernail painting

If you find your child has more energy at a certain time of day, focus on using these moments to their fullest.

To avoid choking for small children, cut the following foods into very small pieces: grapes and other fruit, hot dogs and spaghetti. Older children, adolescents and adults should avoid chewing gum or laughing while eating. Be conscious of chewing thoroughly before swallowing.

Try to avoid dropping food or fluids into the vest while eating or drinking. Crackers, crispy or flaky foods, and potato chips are susceptible to this. To help prevent spilling, place a towel or bib over the vest.

A straw may also be useful for young children who tend to tilt their head back while drinking liquids. They will not be able to do this while wearing a halo.

Visiting restaurants during the postoperative period is allowed. However, for both children and adults, give special consideration to the possibility of choking.

It may take some time to get used to sleeping in a halo, and your child will require assistance getting into the bed. Nighttime suggestions include sleeping in a reclining chair and lying on the back with a small pillow or foam wedge. Eventually, sleeping on a side or on the stomach may be possible.

When getting up, it is important to not sit upright and bend at the waist. This places a great amount of stress on the entire brace.

Instead:

• Roll onto your side at the edge of the bed.
• Bend the legs up from the waist.
• Drop the legs off the edge of the bed, pushing sideways with the elbow and hand at the same time to elevate to a sitting position.

Someone should sleep in the same room as the person with the halo or use an audio/video monitor to prevent issues such as choking.

Shirts may need to be modified to fit around the halo and vest by cutting them to enlarge the head opening. Families with children in halos have found the addition of snaps very helpful. Velcro may also assist with clothing adaptations.

In cooler months, a jacket will be needed outside for warmth. If necessary, alter jackets the same way as shirts.

Undergarments may include a stockinette, which is like a T-shirt underneath the vest. It is placed at the time of the vest and halo application. The vest may also be lined with sheepskin. Do not place additional clothing under the vest.

The doctor will assess your child’s ability to walk. Shoes and boots with low heels and traction are best for safety. If your child has a change in balance, it may increase the likelihood of slipping and falling. Remember to be especially careful during the winter months on icy and/or wet surfaces. Walking in a well-lit mall is one way to exercise and reduce the risk of slipping or falling during rainy or cold weather.

Riding in cars is acceptable, especially related to doctor’s appointments. Long rides may need to be avoided due to fatigue and distance. If your child has a problem with traveling to doctor’s appointments, notify the surgeon.

It’s advised not to leave the country, take cruises or ride motorcycles while wearing a halo brace. These forms of travel are best left for when the halo is removed and healing has fully occurred, with the surgeon’s approval. Avoid rough or off-road traveling.

Soaking in a tub and showering are not possible while wearing a halo brace, so sponge baths are a must.

Do not allow water or soap to enter the vest, as this can create a breeding ground for bacteria. All exposed areas below and around the vest can be cleaned. Use a soft cloth to remove any skin moisture around and underneath the vest edges.

Nothing should come between the skin and the sheepskin of the vest, including powders, talc, perfumes, lotions and ointments.

Discuss your child’s hair care with the doctor. Some doctors will allow certain types of hair care products, but others may ask that they be avoided. Ask your physician if dry shampoo can be used.

Cleaning pin sites is the No. 1 precaution that families can take to avoid infection and pin loosening. Pin inspection should become routine, preferably twice a day: once in the morning and again before bed. The doctor will let you know which type of pin-site care they recommend.

Many physicians will advise cleaning halo pins with half-strength hydrogen peroxide and normal saline using a clean cotton swab for each pin. Take care to avoid re-dipping used cotton swabs into the cleaning solution.

Examine the pins and insertion sites for crusting, drainage, redness, tenderness or swelling. If these symptoms occur, notify your doctor immediately.

Check skin twice a day for any areas of redness, drainage or discoloration. Notify your child’s doctor immediately if you see any of these symptoms.

Inspect all areas around the vest, especially where the vest edges meet the skin. A flashlight works well in rooms with poor lighting. Notify your doctor if there are any areas of rubbing, because this can lead to skin breakdown.

Remember that children respond to attitude. Always be calm and encouraging around your child. The outcome is much more positive with an optimistic attitude and outlook from both parents and the child. It is important to have a strong support system in place with family, friends and your medical team. This will be a trying period to live through, but a manageable one with proper planning and emotional support.

Depression in caregivers may occur during this time. It may be mild, but in some cases symptoms may feel overwhelming. If you suspect depression, contact your doctor immediately.

Some children feel socially isolated in addition to experiencing eating and sleeping disturbances. Increase social interactions at times like this. Try to have friends or family around to combat isolation and increase joy.

Parents of toddlers should be aware of their child’s temperament, especially during the “terrible twos.” Avoid temper tantrums expressed by throwing oneself on the floor if possible.