Dislocations of the cervical spine: closed reduction under anaesthesia

This paper reviews 101 patients with dislocations and fracture-dislocations of the cervical spine with neurological involvement, treated by closed reduction under anaesthesia. All were admitted to a specialised unit where early accurate diagnosis was followed by the application of Crutchfield tongs and an early attempt at closed reduction. Of the 101 patients so treated, 82 were fully reduced. Partial reduction was obtained in six. Open reduction and posterior fusion was performed on four patients following failed closed reduction. Open reduction was not attempted in 9 patients because of their poor general condition. Twenty three patients had delayed spinal fusion because of instability demonstrated radiologically at between 6 weeks and 12 weeks. Of the 56 patients with complete lesions, five showed major neurological recovery after 6 months, and there were 10 deaths at periods from 4 to 25 days after injury. Of the 45 patients with incomplete lesions, six made a full clinical recovery, 28 made major recovery, and there were three deaths from 9 to 14 days after injury. Our results lead us to believe that the method is safe and reliable, even in patients received over 24 hours after the injury.