Awake Early Manual Reduction Is Highly Effective for Subaxial Cervical Spine Dislocation

Introduction: Guidelines published in 2013 recommend early closed reduction for cervical spine dislocation. There are two types of closed reduction: manual reduction and traction. Manual reduction can be performed early. In addition, it can correct rotation and requires a short time for complete reduction. We perform manual reduction for cervical spine dislocation. This study aimed to evaluate early manual reduction's success rate and safety for cervical dislocation. We also examined the relationship between time to reduction and improvement in paralysis. Methods: This retrospective cohort study included 361 patients with cervical spine injuries treated at our hospital between July 2010 and December 2021. We assigned patients to the early group if the time from injury to reduction was <= 6 hours and to the late group if >6 hours. We performed awake manual reduction on the patients. Furthermore, we compared reduction's success rate and safety, including neurological outcomes. Results: Overall, 46 patients were included in the study: 31 and 15 in the early and late groups, respectively. The success rate of reduction was 93%, and no neurological complications from reduction were observed. The neurological outcomes and reduction success rates were significantly superior in the early group than in the late group. Conclusions: Neurological outcomes were significantly superior when reduction was performed within 6 hours than after 6 hours. Manual reduction can be performed early, safely, and easily. It is effective for cervical spine dislocation requiring early reduction for an excellent neurologic prognosis.