[Expert Solution]: LOCATION: Inpatient, Hospital PATIENT:…

LOCATION: Inpatient, Hospital PATIENT: Edward Ridgeline SURGEON: John Hodgson, M.D. PREOPERATIVE DIAGNOSIS: Neck injury, motor vehicle accident. POSTOPERATIVE DIAGNOSIS: Same. PROCEDURE PERFORMED: Placement of halo crown and vest. ANESTHESIA: Local. SURGICAL INDICATIONS: This 43-year-old patient was in a motor vehicle accident and appears to have sustained a spinal cord injury with ligamentous instability at C4-5. He could not be placed in a neck collar because he has a short, thick neck and also because he had a tracheostomy tube. The patient would not be stabilized with traction as he has a distraction injury. It was indicated to place him in a halo vest and crown to immobilize his neck. PROCEDURE: The hair was shaved behind both ears. There was a sterile prep done along the forehead region and the region behind both ears. The halo crown was then positioned and stabilized with the three positioners anteriorly and two laterally. I then injected Xylocaine behind both ears and along the supraorbital ridge laterally. I then placed the four pins and torqued them to 8 pounds per sq inch. The hexagonal lock nuts were then tightened. The patient tolerated this well without any apparent complications. The halo vest was then connected to the crown. The crown was placed. A large vest was used, but this was still too small for the patient, and on the right side the vest had to be tied with string until some permanent straps could be fashioned by orthotics. During the placement of the vest, I maintained the neck in neutral position and at no time was there any rotation or flexion or extension of the neck. Disposition of the patient: The patient tolerated the procedure well and was transferred to the recovery area in good condition. idc10cm idc10cpt