Manipulation for cervical spinal dislocation under general anaesthesia: serial review for 4 years

Abstract

Manipulation under anaesthesia is an important method to reduce cervical spinal dislocations in the acute stage. Causes of failure have not been clearly identi®ed and neurological complications can be the major concern. All cervical dislocations have been traditionally treated by manipulation under anaesthesia in the Christchurch Spinal Injuries Unit as the primary treatment. We reviewed all 31 patients treated from 1991 ± 1995, with detailed documentation of neurological progression and ®nal outcome. Three patterns were identi®ed: bilateral dislocation, unifacet dislocation and fracture dislocation. Most of the dislocations (74%) were successfully reduced by manipulation alone with minimum complications. The remaining 26% patients required open reduction. The predominant causes of failure of reduction by manipulation were co-existing fractures. The success rate of reduction by manipulation was 90% for pure bifacet and unifacet dislocations, but was only 22% for the fracture dislocations. The study concluded that manipulation under anaesthesia is a safe and e ective procedure for pure cervical spinal dislocations. Fractures related to the dislocation should be identi®ed early and open reduction be considered.

Emerging cervical spine surgery in Chitwan Medical College: A case series

“…Acute closed reduction with gradual increment of weight in awake patient yielded good result. 2 In our series we achieved acute closed reduction with gradual increase of weight under general anesthesia for all the five patients. No detoriation of neurological symptoms were noted.…”

“…2,5,6 However, the neurological detoration after closed manipulation is very high. Acute closed reduction with gradual increment of weight in awake patient yielded good result.…”

“…2 All patients were operated from anterior approach. Patient with dislocation underwent anterior cervical disectomy and fusion (ACDF) and patient with fractures underwent anterior cervical corpectomy and fusion (ACCF).…”

Reduction of Lower Cervical Facet Dislocation: A Review of All Techniques

“…However, there were also many authors who believed that manipulation under anesthesia was still a frequently practiced technique, usually used after failwww.e-neurospine.org 183 ure of traction-reduction but occasionally used as a primary means of achieving reduction. 11,30,31 Thirdly, the need for magnetic resonance imaging (MRI) before reduction is a matter of debate. Some investigators believed that disc disruption in association with facet fracture-dislocation increases the risk of spinal cord injury by disc material after reduction.…”