The case for early treatment of dislocations of the cervical spine with cord involvement sustained playing rugby

Abstract

The most common injury in rugby resulting in spinal cord injury (SCI) is cervical facet dislocation. We report on the outcome of a series of 57 patients with acute SCI and facet dislocation sustained when playing rugby and treated by reduction between 1988 and 2000 in Conradie Hospital, Cape Town. A total of 32 patients were completely paralysed at the time of reduction. Of these 32, eight were reduced within four hours of injury and five of them made a full recovery. Of the remaining 24 who were reduced after four hours of injury, none made a full recovery and only one made a partial recovery that was useful. Our results suggest that low-velocity trauma causing SCI, such as might occur in a rugby accident, presents an opportunity for secondary prevention of permanent SCI. In these cases the permanent damage appears to result from secondary injury, rather than primary mechanical spinal cord damage. In common with other central nervous system injuries where ischaemia determines the outcome, the time from injury to reduction, and hence reperfusion, is probably important. In order to prevent permanent neurological damage after rugby injuries, cervical facet dislocations should probably be reduced within four hours of injury.

Urgent closed reduction of the dislocated cervical spine in New Zealand

“…The cervical level treated spanned from C2/3 to C7/T1. In 12 studies, the injury patterns treated were restricted to unifacet and bifacet dislocations, while five studies included fracture dislocations . Common exclusion criteria included skull fracture, Glasgow coma scale <13, insufficient consciousness to report neurological changes during closed reduction, prior neurological deficits, injury severity score >16 or >30 and ankylosing spinal conditions, for example, diffuse idiopathic skeletal hyperostosis …”

“…All but one study concluded that closed reduction using craniocervical traction was a safe and effective means of reducing facet dislocation. Five studies associated early decompression with optimal neurological outcome …”

“…The eight studies that detailed the traction protocol used in their study are summarized in Table . Closed reductions occurred in various environments including the emergency department, intensive care unit and operating theatres …”

“…The recommended amount of initial weight to be applied ranged from 10 lb, 5 kg, 3 to 5 lb/level or 5 kg + 2.5 kg/level. Incremental increases varied between 10 lb/5 and 30 min or 1 and 2.5 kg/15 and 30 min . Obtaining a lateral X‐ray and neurological examination at each weight increase was commonly advised.…”

Management of Traumatic Spinal Fracture in Patient with Coronavirus Disease 2019 Situation

“…In traumatic spinal cord injury (SCI), the timing of the surgery is an important variable related to its neurological outcome. Despite the recent guidelines recommend to perform the surgical treatment within 24 hours for all SCI patients and many authors advocated a so called ultra-early surgery (<12 hours) [2,3], still today the optimal timeframe remain unknown. At our institution, the results of the COVID-19 swab test may be obtained in 4-6 hours.…”