CLOSED REDUCTION OF TRAUMATIC CERVICAL-SPINE DISLOCATION USING TRACTION WEIGHTS UP TO 140 POUNDS

The purpose of this study was to demonstrate that Gardner-Wells skull tong traction up to 140 lb was both safe and effective in reducing dislocation, without fractures, of facet joints involving the C4-C7 vertebral bodies when applied by experienced practitioners in a spinal cord injury center under close scrutiny. Twenty-four awake patients were selected for the study (age range, 16-82 years). These patients were evaluated for the number of millimeters (7-17 mm) of dislocation as measured from the posterior aspect of the superior vertebral body to the posterior aspect of the inferior vertebral body at the level of injury. The maximum weight required to produce the reduction of the facet joints and the time from the onset of traction were recorded. The patients' neurologic status was monitored before traction, after each increment in weight applied, and after reduction. Careful examination of motor function and sensation was done and recorded at each interval. The 24 patients with cervical spine dislocation of the facet joints underwent successful reduction with traction weights (range, 10-140 lb). Seventeen patients required weights of more than 50 lb. The traction procedures lasted for a period of 8-187 minutes per procedure. Worsening neurologic status did not occur in any of the patients involved in this study. These results supported the hypothesis that, in experienced hands in a spinal cord injury center, the use of Gardner-Wells skull tong traction with weights up to 140 lb applied under close scrutiny was an acceptable, safe, and effective method of reducing a dislocation of the facet joints in the absence of fractures at the C3-C7 level in this group of patients.