Halo Vest Usage Trend, Past and Present. Is it Still a Choice of Treatment?

Background/Objectives: In the past few decades, there have been advancements in surgical techniques, improved understanding of spinal biomechanics, and awareness of complications associated with Halo Vest (HV) use with resultant surgical treatment of various pathologies that cause acute or chronic atlanto-axial instability. The purpose of this study was to see how HV usage has changed over time. Methods: A retrospective analysis of the North American Clinical Trials Network database. Patients with cervical spinal cord in-jury from 2006 through 2019 were identified and trend of HV use was analyzed. Results: The mean age of patients who received HV was 37.4 years and 50 for those treated with other options, P < 0.0001. Its use consistently declined after 2009. After 2015 this decline reached nil in the database (P < 0.0001). Patients between 45 and 59 years (3.4%) and above 60 years (2.8%) group had the least treatment using HV. Fall accident (4.7%, P = 0.0295) and Central cord syndrome (4.6%, P = 0.0004) were associated with low HV use. Pulmonary complications were higher (89.4%) with HV use (vs. 65.9% with no HV), P = 0.0008. Pulmonary complications with HV decreased after 2012. Conclusions: HV as treatment option for conditions involving the cervical Spine has decreased. This declining trend is attributable to decreased use in older individuals due to higher rates of complications and unfavorable outcomes with its use. The decreasing trend appears to coincide with published data showing better outcomes with surgical treatment and unfavorable outcomes with HV use.