Dysphagia is said to occur in 2% of patients immobilized in a Halo-Vest for the treatment of cervical injuries. This has been reported to lead to aspiration pneumonia which has a significant mortality rate in the elderly. In our experience dysphagia is a far greater problem than reported and is proportional to the degree of cervical spine extension.

The aim of our study was to ascertain the effect of cervical spine extension on swallowing in normal volunteers immobilized in a Halo- vest.

A halo vest was used to immobilize the cervical spine and to vary the degree of extension in ten volunteers. Videoflouroscopic studies were performed for each volunteer using three consistencies – liquid, paste and biscuit. The study was performed in neutral, 20° and 40° of extension. A subjective rating scale was completed by each volunteer. Videoflouroscopic study were blindly analysed by a radiologist and a speech and language therapist. Fourteen parameters were measured and recorded for each swallow.

Subjectively there was significantly increasing level of difficulty experienced for each swallow. At both degrees of extension there was a significant difference in oral transit time, piecemeal deglutition, Laryngeal penetration (a highly significant risk factor for aspiration), amount of residue occurring at the level of the valleculae and the number of successive clearance swallows compared to control.

In conclusion this study has clearly demonstrated significant impairment in deglutition following halo vest application. This impairment is directly related to the degree of neck extension. These findings should be taken into careful consideration when managing patients in cervical orthoses.