Closed reduction of dislocations of the lower cervical spine

Dislocation of the lower cervical spine (C3-T1) is associated with a high incidence of neurologic injury. Attempted closed reduction by skeletal traction with weights ranging up to 50 lb (23 kg) is considered standard care in North America, although these attempts are often unsuccessful. This retrospective review, over a 6-year span, of 39 patients with dislocations and facet locks of the lower cervical spine treated with closed reduction showed that 35 (90%) were successful. Recommended weight was exceeded in 22 patients (63%) with no deteriorations in neurologic status. If patients are monitored radiologically and neurologically throughout traction, up to 70% of body weight can be used safely. An algorithm for treatment is provided.