title: Magnetic resonance evaluation of the intervertebral disc, spinal ligaments, and spinal cord before and after closed traction reduction of cervical spine dislocations.
abstract: METHODS
  A prospective clinical study using magnetic resonance imaging of the cervical spine in a consecutive series of patients with cervical spine dislocations.
  
  
  OBJECTIVE
  To determine the incidence of intervertebral disc herniations and injury to the spinal ligaments before and after awake closed traction reduction of cervical spine dislocations.
  
  
  BACKGROUND
  Prior series in which the prereduction imaging of disc herniations in the dislocated cervical spine are described have been anecdotal and have involved small numbers of patients. In addition, no uniform clinical criteria to define the presence of an intervertebral disc herniation in the dislocated cervical spine has been described. The incidence of disc herniations in the unreduced dislocated cervical spine is unknown.
  
  
  METHODS
  Eleven consecutive patients with cervical spine dislocations who met the clinical criteria for an awake closed traction reduction had prereduction and postreduction magnetic resonance imaging. Using strict clinical criteria for the definition of an intervertebral disc herniation, the presence or absence of disc herniation, spinal ligament injury, and cord injury was determined. Neurologic status before, during, and after the closed reduction maneuver was documented.
  
  
  RESULTS
  Disc herniations were identified in 2 of 11 patients before reduction. Awake closed traction reduction was successful in 9 of the 11 patients. Of the nine patients with a successful closed reduction, two had disc herniations before reduction, and five had disc herniations after reduction. No patient had neurologic worsening after attempted awake closed traction reduction.
  
  
  CONCLUSIONS
  The process of closed traction reduction appears to increase the incidence of intervertebral disc herniations. The relation of these findings, however, to the neurologic safety of awake closed traction reduction remain unclear.
authors.affiliation: Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
authors.forename: A R
authors.initials: AR
authors.lastname: Vaccaro
authors.forename: S P
authors.initials: SP
authors.lastname: Falatyn
authors.forename: A E
authors.initials: AE
authors.lastname: Flanders
authors.forename: R A
authors.initials: RA
authors.lastname: Balderston
authors.forename: B E
authors.initials: BE
authors.lastname: Northrup
authors.forename: J M
authors.initials: JM
authors.lastname: Cotler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000473:pathology*; D005260:Female; D006801:Humans; D007403:Intervertebral Disc / Q000000981:diagnostic imaging / Q000293:injuries / Q000473:pathology*; D007405:Intervertebral Disc Displacement / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D017846:Longitudinal Ligaments / Q000000981:diagnostic imaging / Q000293:injuries / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D013116:Spinal Cord / Q000000981:diagnostic imaging / Q000473:pathology*; D013119:Spinal Cord Injuries / Q000175:diagnosis*; D014143:Traction / Q000009:adverse effects*