Abstract
The objective of our study is to report a rare complication of halo pin insertion associated with an epileptic seizure and brain abscess, and to discuss the diagnostic and therapeutic approach to its management. The treatment of unstable cervical spine injuries with a halo vest is an established procedure. Complications of pin penetration such as brain abscess and seizure are rare, and need to be urgently treated. Intracranial abscess and seizure associated with the use of the halo device is an unusual complication, and only a few cases have been reported in the literature. A 21-year-old male had a halo vest placed for the management of an odontoid type II fracture, which he sustained from a motor vehicle accident. Ten weeks after halo ring placement he complained of headaches which relieved by analgesics. After 2 weeks he was admitted at the emergency unit in an unconscious condition after a generalized tonic-clonic seizure. The halo pins were displaced during the seizure and were removed at his admission. No drainage was noted from the pin sites, and a Philadelphia cervical collar was applied. A brain CT and MRI revealed intracranial penetration of both posterior pins and a brain abscess in the right parietal lobe. Computed tomography of the cervical spine revealed stable fusion of the odontoid fracture. Cultures from the pin sites were negative; however, intravenous wide spectrum antibiotic treatment was administered to the patient immediately for 4 weeks followed by oral antibiotics for additional 2 weeks. Anti-epileptic medication was also started at his admission. The patient was discharged from the hospital in 6 weeks without symptoms, continuing anti-epileptic medication. On the follow-up visits he had fully recovered without any neurologic sequelae. In conclusion, complications of halo pin penetration are rare which need immediate intervention. Any neurologic or infectious, local or generalized, symptom need to be investigated urgently with available imaging techniques and treated promptly. Pin over-tightening may cause bone penetration and possible deep cranial infection with serious complications.
References
Aderson LD, D’Alonzo RT (1974) Fractures of the odontoid process of the axis. J Bone Joint Surg Am 56:1663–1674
Clark C, White A (1985) Fractures of the dens: a multicenter study. J Bone Joint Surg Am 67:1340–1348
Dennis GC, Clifton GL (1982) Brain abscess as a complication of halo fixation. Neurosurgery 10:760–761. doi:10.1097/00006123-198206010-00017
Frangen T, Zilkens C, Muhr G (2007) Odontoid fractures in the elderly: dorsal C1/C2 fusion is superior to Halo-Vest immobilization. J Trauma 63:83–89. doi:10.1097/TA.0b013e318060d2b9
Garfin S, Botte M, Waters R (1986) Complications in the use of halofixation device. J Bone Joint Surg Am 65:320–325
Glaser J, Whitehill R, Stamp W (1986) Complications associated with the halo vest. A review of 265 cases. J Neurosurg 65:762–769
Goodman ML, Nelson PB (1987) Brain abscess complicating the use of a halo orthosis. Neurosurgery 20:27–30. doi:10.1097/00006123-198701000-00007
Hashimoto Y, Doita M, Hasuda K et al (2004) Intracerebral pneumonocephalus and hemiparesis as a complication of a halo vest in a patient with multiple myeloma. J Neurosurg 100:367–371
Humbyrd DE, Latimer FR, Lonstein JE et al (1981) Brain abscess as a complication of halo traction. Spine 6:365–368. doi:10.1097/00007632-198107000-00006
Kingma R, Peters JM, Coene LNGEM (2006) Intracranial penetration of a halo pin causing an epileptic seizure. J Bone Joint Surg Br 88:1654–1655. doi:10.1302/0301-620X.88B12.17562
Koivikko M, Kiuru M, Koskinen S et al (2004) Factors associated with non-union in conservatively-treated type-II fractures of the odontoid process. J Bone Joint Surg Br 86:1146–1151. doi:10.1302/0301-620X.86B8.14839
Komadina R, Brilej D, Kosanovic M et al (2003) Halo jacket in adontoid fractures type II and III. Arch Orthop Trauma Surg 123:64–67
Muller EJ, Wick M, Muhr G (1998) Subdural absess as a complication of halo fixator. Unfallchirurg 101:655–657. doi:10.1007/s001130050319
Nottmeier EW, Bondurany CP (2000) Delayed onset of generalized tonic-clonic seizures as a complication of halo orthosis. Case report. J Neurosurg 92:233–235
Ochoa G (2005) Surgical management of odontoid fractures. Injury 36:54–64. doi:10.1016/j.injury.2005.06.015
Platzer P, Thaihammer G, Sarahrudi K et al (2007) Nonoperative management of odontoid fractures using a halothoracic vest. Neurosurg 61:522–530
Rizzolo SJ, Piazza MR, Cotler JM et al (1993) The effect of torque pressure on halo pin complication rates: a randomized prospective study. Spine 18:2163–2166. doi:10.1097/00007632-199311000-00003
Rosenblum D, Ehrlich V (1995) Brain abscess and psychosis as a complication of a halo orthosis. Arch Phys Med Rehabil 76:865–867. doi:10.1016/S0003-9993(95)80553-2
Saeed MU, Dacuycuy MAC, Kennedy DJ (2007) Halo pin insertion associated brain abscess: case report and review of literature. Spine 32:271–274. doi:10.1097/01.brs.0000259976.46403.8a
Strohm PC, Muller Ch A, Kostler W et al (2007) Halo-fixator vest—indications and complications. Zentralbl Chir 132:54–59. doi:10.1055/s-2006-960479
Vertullo C, Duke P, Askin G et al (1997) Pin-site complications of the halo thoracic brace with routine pin re-tightening. Spine 22:2514–2516. doi:10.1097/00007632-199711010-00010
Victor DI, Bresnan MJ, Keller RB (1973) Brain abscess complicating the use of halo traction. J Bone Joint Surg Am 55:635–639
Conflict of interest statement
None of the authors has any potential conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Gelalis, I.D., Christoforou, G., Motsis, E. et al. Brain abscess and generalized seizure caused by halo pin intracranial penetration: case report and review of the literature. Eur Spine J 18 (Suppl 2), 172–175 (2009). https://doi.org/10.1007/s00586-008-0759-x
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-008-0759-x