Efficacy of halo-vest fixation in the assessment and prediction of the effectiveness of permanent fixation in a patient with basilar invagination with ambiguous vertebral instability

Basilar invagination is a developmental anomaly of the craniovertebral junction in which the odontoid abnormally prolapses into the foramen magnum. It is also associated with Chiari malformation, syringomyelia, and hydrocephalus. Patients require surgical treatment to prevent progression of neurological symptoms, but assessment of anterior or posterior decompression can be difficult owing to bone instability and ambiguous compression of neural structures. Here. we describe a case of basilar invagination in a young adult. He presented with neurological symptoms, including syringomyelia. 3 months after a traffic trauma that might have led to instability of the bony structures. Since it was unclear whether the instability of the bony structures contributed to the clinical deterioration, the patient was first treated using halo-vest fixation. Significant improvements were observed in both neurological symptoms and magnetic resonance images. These results justified the invasive fixation and the patient was treated further with an occipito-cervical fusion 1 good results were achieved in this case. Owing to the invasiveness of the procedure, occipito-cervical fixation should only be adopted following stnct indication criteria. Halo-vest fixation was effective in treating the instability of the bony structures and as a trial treatment for permanent fixation.