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Risk of early closed reduction in cervical spine subluxation injuries.

Publication ,  Journal Article
Grant, GA; Mirza, SK; Chapman, JR; Winn, HR; Newell, DW; Jones, DT; Grady, MS
Published in: J Neurosurg
January 1999

OBJECT: The authors retrospectively reviewed 121 patients with traumatic cervical spine injuries to determine the risk of neurological deterioration following early closed reduction. METHODS: After excluding minor fractures and injuries without subluxation, the medical records and imaging studies (computerized tomography and magnetic resonance [MR] images) of 82 patients with bilateral and unilateral locked facet dislocations, burst fractures, extension injuries, or miscellaneous cervical fractures with subluxation were reviewed. Disc injury was defined on MR imaging as the presence of herniation or disruption: a herniation was described as deforming the thecal sac or nerve roots, and a disruption was defined as a disc with high T2-weighted signal characteristics in a widened disc space. Fifty-eight percent of patients presented with complete or incomplete spinal cord injuries. Thirteen percent of patients presented with a cervical radiculopathy, 22% were intact, and 9% had only transient neurological deficits in the field. Early, rapid closed reduction, using serial plain radiographs or fluoroscopy and Gardner-Wells craniocervical traction, was achieved in 97.6% of patients. In two patients (2.4%) closed reduction failed and they underwent emergency open surgical reduction. The average time to achieve closed reduction was 2.1+/-0.24 hours (standard error of the mean). The incidence of disc herniation and disruption in the 80 patients who underwent postreduction MR imaging was 22% and 24%, respectively. However, the presence of disc herniation or disruption did not affect the degree of neurological recovery, as measured by American Spinal Injury Association motor score and the Frankel scale following early closed reduction. Only one (1.3%) of 80 patients deteriorated, but that occurred more than 6 hours following closed reduction. CONCLUSIONS: Although disc herniation and disruption can occur following all types of traumatic cervical fracture subluxations, the incidence of neurological deterioration following closed reduction in these patients is rare. The authors recommend early closed reduction in patients presenting with significant motor deficits without prior MR imaging.

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Published In

J Neurosurg

DOI

ISSN

0022-3085

Publication Date

January 1999

Volume

90

Issue

1 Suppl

Start / End Page

13 / 18

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Spinal Injuries
  • Spinal Fractures
  • Retrospective Studies
  • Neurology & Neurosurgery
  • Manipulation, Spinal
  • Magnetic Resonance Imaging
  • Joint Dislocations
  • Intervertebral Disc Displacement
  • Humans
 

Citation

APA
Chicago
ICMJE
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Grant, G. A., Mirza, S. K., Chapman, J. R., Winn, H. R., Newell, D. W., Jones, D. T., & Grady, M. S. (1999). Risk of early closed reduction in cervical spine subluxation injuries. J Neurosurg, 90(1 Suppl), 13–18. https://doi.org/10.3171/spi.1999.90.1.0013
Grant, G. A., S. K. Mirza, J. R. Chapman, H. R. Winn, D. W. Newell, D. T. Jones, and M. S. Grady. “Risk of early closed reduction in cervical spine subluxation injuries.J Neurosurg 90, no. 1 Suppl (January 1999): 13–18. https://doi.org/10.3171/spi.1999.90.1.0013.
Grant GA, Mirza SK, Chapman JR, Winn HR, Newell DW, Jones DT, et al. Risk of early closed reduction in cervical spine subluxation injuries. J Neurosurg. 1999 Jan;90(1 Suppl):13–8.
Grant, G. A., et al. “Risk of early closed reduction in cervical spine subluxation injuries.J Neurosurg, vol. 90, no. 1 Suppl, Jan. 1999, pp. 13–18. Pubmed, doi:10.3171/spi.1999.90.1.0013.
Grant GA, Mirza SK, Chapman JR, Winn HR, Newell DW, Jones DT, Grady MS. Risk of early closed reduction in cervical spine subluxation injuries. J Neurosurg. 1999 Jan;90(1 Suppl):13–18.

Published In

J Neurosurg

DOI

ISSN

0022-3085

Publication Date

January 1999

Volume

90

Issue

1 Suppl

Start / End Page

13 / 18

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Spinal Injuries
  • Spinal Fractures
  • Retrospective Studies
  • Neurology & Neurosurgery
  • Manipulation, Spinal
  • Magnetic Resonance Imaging
  • Joint Dislocations
  • Intervertebral Disc Displacement
  • Humans