Reduction technique for uni- and biarticular dislocations of the lower cervical spine.

STUDY DESIGN

A technical report concerning the methods of reduction of dislocations of the lower cervical spine used in 168 consecutive cases (77 unilateral and 91 bilateral dislocations).

OBJECTIVES

To evaluate the efficacy of a reduction protocol comprising three successive phases: reduction by traction, reduction by closed maneuvers with the patient under general anesthesia, and open reduction.

SUMMARY OF BACKGROUND DATA

Management of cervical dislocations varies greatly among spine treatment centers, especially concerning the upper limit of traction, the safety of closed manipulations in anesthetized patients, and the approach preferred when surgical reduction is necessary.

METHODS

Reduction by gradual traction without anesthesia was attempted first. In case of failure, specific closed manipulations were used with the patient under general anesthesia just before anterior arthrodesis was performed. If this failed, anterior surgical reduction was attempted. Anterior fusion was performed in every patient, even when closed reduction was successful, because of the lasting instability produced by attending ligamentous lesions.

RESULTS

Of the patients in 168 cases of dislocation, the protocol failed in 5, all of whom had longstanding unilateral dislocation. Of the 91 with bilateral dislocation, reduction was achieved by simple traction in 39 (43%), by maneuvers with the patient under general anesthesia in 27 (30%), and by anterior surgery in 25 (27%). Among the patients in 77 cases of unilateral dislocation, reduction was achieved by traction in 18 (23%), by external maneuvers in 28 (36%), and by anterior surgery in 26 (34%). In 7 patients, discal herniation engendering neurologic signs was resected during anterior surgery. No neurologic deterioration during or immediately after reduction by this protocol was observed.

CONCLUSIONS

This protocol consists of application of rapidly progressive traction, followed if necessary by one or two reduction maneuvers with the patient under general anesthesia. If both methods fail, specific surgical procedures using an anterior exposure seem to be reliable, in that anatomic reduction was obtained in 163 of 168 patients without neurologic deterioration.