title: Early versus delayed reduction of cervical spine dislocation with complete motor paralysis: a multicenter study.
abstract: Reduction of cervical facet dislocation should be performed as soon as possible to depressurize neuron cells although some randomized control studies defined early reduction as over 24 h after trauma. The purpose of this study was to define the actual time limit for early reduction in patients with complete motor paralysis.
  
  
  
  Cervical spine dislocation patients with complete motor paralysis admitted between April 2007 and December 2014 were analyzed as retrospective cohort study. We separated the patients into three groups according to the number of hours lapsed between the trauma and reduction, within 4 h (very early group), >4-6 h (early group), and >6 h (delayed group). We compared the neurological outcomes, patient injury patterns, the arrival time at the hospital, and the injury severity score (ISS).
  
  
  
  Of 30 patients who enrolled, 8 (27%) were recovered to American Spinal Injury Association Impairment Scale Grades C-E. The delayed group had poorer neurological outcomes than the very early group and early group, although no significant differences were noted in the recovery rate between the very early group and early groups. The injury pattern, arrival time, and ISS were not found to be associated with the neurological outcome.
  
  
  
  Our data suggest that early (<6 h) reduction of cervical spine dislocation is associated with favorable neurological outcome as compared with those performed after 6 h.
authors.affiliation: Department of Orthopaedic Surgery, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan. koseinagata1984@gmail.com.
authors.forename: Kosei
authors.initials: K
authors.lastname: Nagata
authors.affiliation: Saitama Medical Center, Saitama Medical University, Saitama, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Inokuchi
authors.affiliation: The University of Tokyo Hospital, Tokyo, Japan.
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Chikuda
authors.affiliation: Department of Orthopaedic Surgery, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Ishii
authors.affiliation: Department of Orthopaedic Surgery, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan.
authors.forename: Atsuki
authors.initials: A
authors.lastname: Kobayashi
authors.affiliation: Department of Orthopaedic Surgery, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kanai
authors.affiliation: Yokohama Rosai Hospital, Yokohama, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nakarai
authors.affiliation: Yokohama Rosai Hospital, Yokohama, Japan.
authors.forename: Kota
authors.initials: K
authors.lastname: Miyoshi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000293:injuries* / Q000601:surgery; D000070628:Closed Fracture Reduction; D015331:Cohort Studies; D019299:Decompression, Surgical; D004185:Disability Evaluation; D016267:External Fixators; D005260:Female; D006801:Humans; D004204:Joint Dislocations / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D000070799:Open Fracture Reduction; D010243:Paralysis / Q000209:etiology; D020127:Recovery of Function; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000209:etiology / Q000628:therapy; D061665:Time-to-Treatment; D055815:Young Adult; D021801:Zygapophyseal Joint / Q000293:injuries* / Q000601:surgery
keywords: Cervical spine dislocation; Complete motor paralysis; Early reduction; Spinal cord injury