A halo brace holds your head and neck still so the bones and ligaments of the neck can heal after an injury or surgery. Your head and trunk will move as one when you are moving around. You can still do many activities when wearing a Halo brace.

This article is about halo brace care in adults. To learn about halo brace care in children, please see the article Halo brace - child.

There are two parts to a halo brace:

• The halo ring that goes around your head. The ring is attached to your head with 4 or more small pins that anchor it into the bone of your head.
• A stiff vest that is worn under clothes. Four rods go down from the halo ring and connect to the shoulders of the vest.

Talk to your health care provider about how long you will wear the halo brace. Most people will need to wear the brace for 2 to 4 months, depending on the injury and how fast it heals. The halo brace stays on at all times, day and night. Only your provider will take it off. Your provider will do x-rays to see if your neck has healed. The halo brace can be removed in the office.

Halo orthosis; Halo ring; Halo vest

It takes about 1 to 2 hours to put on the halo brace.

Your provider will numb the skin where the pins will be put in. You will feel pressure when the pins go in. X-rays are taken to make sure the brace is keeping your neck straight. Your provider may have to readjust it to get the best alignment of your neck.

Wearing the halo brace should not be painful. When you first start wearing the brace, you may notice the pin sites hurting, your forehead hurting, or you may have a headache. The pain may be worse when you chew or yawn. Most people get used to the brace, and the pain goes away. If the pain does not go away or gets worse, the pins may need to be adjusted. DO NOT do this yourself. Contact your provider.

If the vest is not fitted well, you may feel pressure points over your shoulder or back, especially during the first few days. You should report this to your provider. The vest can be adjusted, and pads can be put in place to avoid pressure points and skin damage.

While you are wearing the halo brace, you will need to learn to care for your skin.

PIN CARE

Clean the pin sites once or twice a day, or as directed by your provider. Sometimes, a crust forms around the pins. Clean the area this way to prevent infection:

• Wash your hands with soap and water.
• Dip a cotton swab into a skin-cleaning solution, such as hydrogen peroxide, povidone iodine, or another antiseptic your provider recommends. Use the cotton swab to wipe and scrub around one pin site. Make sure to remove any crust.
• Use a new cotton swab with each pin.
• You can apply antibiotic ointment daily at the point where the pin enters into the skin.

Check the pin sites for infection. Contact your provider if you have any of these signs of infection at a pin site:

• Redness or swelling
• Pus
• Open or infected wounds
• Increased pain

HOW TO BATHE

Do not shower or get in a bath. The halo brace should not get wet. You will need someone to help you wash yourself, following these steps:

• Cover the edges of the vest with a dry towel. Cut holes in a plastic bag for your head and arms and put it over the vest.
• Sit in a chair.
• Wash yourself with a damp washcloth and mild soap. Wipe off soap with a damp towel. Your helper can wash areas you can’t reach. Do not use sponges that can leak water onto the brace and vest.
• Ask your helper to check for redness or irritation, especially where the vest touches the skin.
• Have your helper shampoo your hair over a sink or tub.
• If the vest and skin under the vest ever get wet, dry the area with a hairdryer set on COOL.

CLEAN THE INSIDE OF THE VEST

• You cannot remove the vest to wash it.
• Dip a long strip of surgical gauze in witch hazel and wring it out, so it is just a little damp.
• Put the gauze through from top to the bottom of the vest and slide it back and forth. This cleans the vest liner. You can also do this if your skin is itchy.
• Use cornstarch baby powder around the edges of the vest to make it feel smoother next to your skin.

You can do your usual activities at home and work.

You will not be able to look down when you walk. Ask for help keeping areas clear of things that can trip you up. You may want to use a cane or walker to help keep steady when walking.

Do not do activities like sports, jogging, or bike riding.

Try to find a comfortable way to sleep. You should be able to sleep the way you usually do, such as on your back, side, or stomach. Try a pillow or a rolled towel under your neck to give support. Use pillows to support the halo.

Contact your provider if:

• Pin sites are red, swollen, or have pus or pain
• You can nod your head
• Any parts of the brace or vest become loose
• You notice any numbness or changes in feeling in your arms, hands, or legs
• You have new neck pain
• You cannot do your usual non-sports activities
• You have difficulty walking
• You have a fever
• You have pain where the vest might be putting too much pressure on your body, such as at the top of the shoulders

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Williams KD. Fractures, Dislocations, and Fracture-Dislocations of the Spine. In: Azar FM, Beaty JH, eds. Campbell's Operative Orthopaedics. 14th ed. Philadelphia, PA: Elsevier; 2021:chap 41.