CERVICAL-SPINE TRAUMA

Study Design. The authors reviewed the results of a large number of studies of patients with acute cervical spine dislocations and subluxations. Objectives. The authors make recommendations regarding the evaluation and treatment of acute cervical spine dislocations based on a thorough review of the available literature. Summary of Background Data. Realization that a significant percentage of patients with acute cervical dislocations also have disc herniations has led to some controversy regarding the timing of MRI evaluation and attempted closed reduction. This article reviews studies of spine dislocations at one institution. Methods. The review of the literature included 131 consecutive patients with acute cervical spine dislocations treated by the senior author followed both retrospectively and prospectively. These results were compared with those of many other authors. Results. Emergent attempted closed reduction remains the treatment of choice for alert cooperative patients with acute cervical spine dislocations. Open or closed reduction under general anesthesia with an uncooperative or unconscious patient should be preceded by an MRI scan. In this situation, the presence of a herniated disc mandates decompression before reduction.