Halo Vest vs. Spinal Fusion: Uses, Benefits, Side Effects, and More

Halo vest and spinal fusion are common treatments for cervical spine (neck) injuries and certain spinal disorders. A halo vest is a brace designed to stabilize and protect the cervical spine. Spinal fusion is a surgical procedure in which two or more spinal vertebrae (bones) are fused into one bone to restore spinal stability.

Though halo vests and spinal fusion treat neck injuries and stabilize the spine, there are key differences between these two treatments. This article explores the differences between a halo vest and spinal fusion. 

What to Know About Halo Vest

A halo vest is an external brace that stabilizes and protects the neck after an injury or surgery. Halo vests commonly:

• Treat a neck/cervical spine injury, such as a fracture or dislocation
• Provide spinal stability and allow for healing after a surgical procedure
• In combination with or after skeletal traction

Halo vest equipment includes:

• A metal ring (halo) attached to the skull with pins
• A plastic or plaster vest lined with fleece (sheepskin) 
• Four rods (uprights) connecting the head ring to the vest

The halo vest is designed to immobilize the head and neck to promote healing and prevent further damage. The vest weighs approximately 7 pounds, making it lightweight enough for users to remain mobile rather than confined to a bed while recovering. There may be an adjustment period as you get used to eating, sleeping, getting dressed, and carrying out your daily activities while wearing the vest. 

How Does It Work? 

A halo vest is the most effective brace for helping the neck heal from injury. It works much like a plaster cast does on other bone fractures, restricting the movement of the injured bone and surrounding soft tissues (e.g., muscle, ligaments, tendons) to promote healing. 

The “halo” ring circles around the head and is attached to the skull with pins (screws). The rigid brace (vest) is attached to the halo ring with bars to provide spinal stability. The halo vest allows the wearer to remain mobile with minimal discomfort. 

Halo Vest Procedure 

Halo vest placement is a straightforward procedure that takes approximately one hour. You will be awake and lie face up on a hospital bed or table throughout the procedure.

Placement of a halo ring and vest generally follows these steps:

• A local anesthetic and antiseptic are applied to numb and sterilize the areas of the head where titanium pins will be placed. 
• Four pins are threaded through the halo ring and anchored to the skull—two above the eyebrows and one behind each ear. The pins help keep the halo ring in place and prevent neck movement.
• The brace (vest) is placed on the chest and torso. This will fit snugly and can be worn under clothes. 
• The vest is connected to the halo ring with adjustable metal rods. 
• X-rays may be taken to ensure the cervical spine is properly aligned for optimal healing.
• Pins on the halo are tightened using a torque screwdriver, and bolts are applied to fully secure the ring.
• Tools (e.g., a special screwdriver) are secured onto the vest shell, allowing emergency vest removal or bolt/pin tightening as needed.

When the procedure is complete, you will visit your healthcare provider frequently so they can closely monitor your recovery. They will perform a neurological examination, tighten the pins as needed, and take regular X-rays to ensure adequate healing and positioning of the cervical spine. 

You must always wear the halo vest unless a healthcare provider advises otherwise. Most people wear a halo vest for six to 12 weeks, depending on the severity of the injury.

Complications

The halo vest is a safe, effective treatment for cervical spine injuries. Potential complications are typically mild and short term. These include:

• Pin loosening: If this occurs, you may feel pain at the pin sites on your head. Your healthcare provider can tighten loose pins as needed.
• Infection at pin sites: Occurs in approximately 17% of people. This can often be avoided by carefully cleaning the pin sites daily.
• Skin irritation: Pressure sores or skin irritation may occur on the skin under the vest. 
• Balance issues: This may occur when you first begin wearing the halo vest but will quickly improve when you adjust to wearing the device.
• Difficulty swallowing: Known as dysphagia, this often improves over time.
• Weakened neck muscles: After the vest is removed, your head may feel heavy or wobbly due to weakened neck muscles from lack of use. Strength is usually restored within a few weeks. 

What to Know About Spinal Fusion 

Spinal fusion is a surgical procedure by which two or more vertebrae in the spine are permanently fused to make one solid bone. Spinal fusion aims to straighten and stabilize the spine and prevent damage to the soft tissues surrounding the affected vertebrae. 

Spinal fusion is often performed to correct the following:

• Spinal injury (e.g., fracture) 
• Degenerative disc disease
• Weak or unstable spine due to infection or tumor 
• Spondylolisthesis (vertebrae in the lumbar/lower spine slip out of position)
• Scoliosis (C- or S-shaped spine)
• Kyphosis (rounded upper back)
• Spinal stenosis (narrowing of the spinal canal)

How Does It Work?

Spinal fusion corrects a spinal deformity or injury and improves spinal stability. Your healthcare provider may recommend spinal fusion if you have considerable back pain during physical activity or movement.

Spinal fusion on the cervical spine is a highly effective and safe procedure for treating conditions and injuries affecting the neck. A research review found that cervical spinal fusion results in high fusion (healing) rates and low rates of complications, with people reporting a significant reduction in pain.

Spinal Fusion Procedure 

Spinal fusion procedures are performed by orthopedic surgeons in hospitals. You will be placed under general anesthesia, so you will not be awake or feel pain during the procedure. A spinal fusion procedure may take several hours and typically proceeds as follows:

• The surgeon makes an incision on your neck or back to access the cervical spine.
• The muscle is moved aside to expose the vertebrae.
• A bone graft (transplanted bone) is placed between the affected vertebrae to help repair and rebuild bone.
• Implants (rods, screws, hooks, or wires) are placed to hold the cervical spine in a straight, stable position to facilitate fusion and healing.
• The surgeon closes the incision with stitches or surgical staples.

You may stay in the hospital for three to four days after the procedure to manage your pain, learn proper movement techniques while you heal, and monitor your condition. You may wear a neck brace when you leave the hospital to keep your neck stabilized while you heal. It may take four to six weeks before you can resume regular activities. 

Complications

Cervical spinal fusion is generally a safe procedure, but there are potential risks and complications, including:

• Infection: Antibiotics are often administered before, during, and after surgery to reduce the risk of infection. 
• Bleeding: Blood loss may occur during the procedure but is usually minimal.  
• Pain at the graft site: Approximately 2.5% of patients whose own bone is used for grafting experience long-term pain at the bone graft site. 
• Pseudoarthrosis: A condition in which not enough bone is formed between the grafted bone and vertebrae to create a solid fusion. Most common in older adults, smokers, and people with diabetes. 
• Nerve and blood vessel damage: In rare cases, nerves and/or blood vessels may be injured during the procedure. 

Which Treatment Is Best for You?

If given the opportunity to choose between a halo vest and spinal fusion, your healthcare provider will discuss your treatment options, including risks and benefits, and offer their recommendation of which may be most effective.

A halo vest may not be an option for people with severe chest trauma, head or facial fractures, a barrel-shaped chest, osteoporosis, or obesity. Cervical spinal fusion may not be appropriate for smokers or people with diabetes and/or mental health disorders. Talk to your healthcare provider about your questions and concerns so you can make an informed decision.

Can Halo Vest and Spinal Fusion Be Used Together? 

A halo vest and spinal fusion are rarely used together, but certain situations may warrant the use of both treatments. For example, a halo vest may be used prior to spinal fusion or afterward to keep the head and neck as still as possible.

Summary

Halo vest and spinal fusion are treatments for injuries and disorders affecting the cervical spine (neck). A halo vest is a brace designed to immobilize and protect the cervical spine after an injury or surgery.

Spinal fusion is a surgical procedure in which two or more spinal vertebrae are fused together into a single bone to restore spinal stability and reduce pain. Both halo vest and spinal fusion are safe and effective treatments. 

A Word From Verywell

Both halo vest and spinal fusion are effective, safe treatments for injuries and conditions affecting the cervical spine. Speak with your healthcare provider about which treatment option is best for you.