Rapid traction for reduction of cervical spine dislocations

Abstract

There is still some controversy about the reduction of unilateral and bilateral facet dislocations in the cervical spine. We have reviewed the notes and radiographs of 210 such patients; reduction was attempted by manipulation under anaesthesia (MUA) in 91, and by rapid traction under sedation in 119, using weights up to 150 lb (68 kg). Our results suggest that early reduction in patients with neurological deficit gives the best chance of neurological recovery, that rapid traction is more often successful than MUA, and that traction is safer than MUA. We found that the use of heavy weights with close monitoring was safe and brought about reduction in an average time of 21 minutes. We recommend this technique for the reduction of all cervical facet dislocations.

Does early decompression improve neurological outcome of spinal cord injured patients? Appraisal of the literature using a meta-analytical approach

“…21,22 Furthermore, definitive and unequivocal evidence to support the practice of early or late surgery are still lacking in clinical studies. 21,[23][24][25][26][27][28][29][30][31][32][33][34][35][36] Recently, in an evidence-based review of the literature, Fehlings and Tator 10 concluded, on the bases of the current knowledge, that early decompression can be considered a practice option. 37 Clinically, the neurological examination within 24 h of injury is fraught with difficulty.…”

Fracture dislocations of the cervical spine: a review of 106 conservatively and operatively treated patients

“…Several reports on various treatment protocols have been published, but surprisingly few [3,16] have compared their benefits and drawbacks. There is controversy as to whether conservative treatment would be sufficient or surgery always necessary [2,8,16]. In recent years, early operative treatment has gained increasing acceptance [1].…”

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

“…Previous studies showed that prompt reduction of dislocation is of paramount importance for patients with signi®cant neurological involvement. 1,5,9 Others, on the other hand, have suggested that patients with incomplete neurological damage can still make signi®cant neurological recovery even when dislocations have been left unreduced. 13 The timing of reduction in patients with minimal neurological de®cits is less critical, though there have been reports of progressive paralysis after bilateral facet dislocation; most occurred outside spinal injury units.…”

“…Yet no uni®ed recommendations have been accepted universally among the three approaches: closed manipulation (MUA), increasing skull traction and open reduction. 1,2,5 There have been increasing concerns over the safety of closed reduction which may cause neurological deterioration particularly secondary to herniated discs. 1 ± 4 Recent studies however indicated that MRI might be over sensitive as there was much less reported neurological involvement related to disc lesions even though the latter were found in up to 80% of dislocations.…”

“…1 ± 4 Recent studies however indicated that MRI might be over sensitive as there was much less reported neurological involvement related to disc lesions even though the latter were found in up to 80% of dislocations. 1,5,10 Manipulation under anaesthesia is an e ective way of reducing the dislocations. However, the failure rate can be high (26% in our series and 27% in Lee's series 1994).…”