Reduction and stabilisation of cervical dislocations. An analysis of 167 cases.
We compared retrospectively consecutive series of patients with cervical dislocation treated at two Australian centres. In Perth, 82 patients were treated by closed reduction and postural nursing. In Adelaide, 85 patients had closed reduction and early surgical stabilisation by interbody fusion. There were 46 bilateral dislocations, 101 unilateral dislocations, and 20 anterior subluxations. On admission 30 patients had complete tetraplegia, 17 incomplete tetraplegia, and 120 had minimal or no neurological loss. Our results indicated that closed manipulation under general anaesthesia is a safe and effective means of reduction in the acute stage. There was a high mortality rate for acute surgery in patients with complete tetraplegia. Early surgical stabilisation by dowel fusion reduced bed and hospital stay in patients with no neurological loss, but seemed to impair neurological recovery in patients with a neurological deficit on admission. Conservative management after reduction of bilateral dislocation or anterior subluxation led to a higher incidence of instability in patients with minimal or no neurological loss; in such cases surgery to stabilise the injured segment is indicated.
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Department of Orthopaedic Surgery and Trauma, Royol Adelaide Hospital, South Australia.
Fraser
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Griffiths
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D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries*; D006801:Humans; D007103:Immobilization; D004204:Joint Dislocations / Q000150:complications / Q000601:surgery / Q000628:therapy*; D007902:Length of Stay; D008349:Manipulation, Orthopedic; D008875:Middle Aged; D011782:Quadriplegia / Q000209:etiology / Q000401:mortality; D011859:Radiography; D012189:Retrospective Studies; D013123:Spinal Fusion