Early Closed Reduction in Patients with Cervical Fracture-Dislocation Injury without Prior Magnetic Resonance Imaging

ABSTRACT

OBJECTIVE: We report an evaluation of incidence of the traumatic disc herniation and an effect of early closed reduction without prior magnetic resonance(MR) imaging in cervical spine fracture-dislocation injury. METHODS: The medical records and radiologic images of twenty consecutive traumatic cervical spine injury from the C2-3 to C7-T1 were reviewed. The disc injury on MR images was divided into two category a herniation defined as deforming the thecal sac or nerve root and a disruption defined as a disc with high T2-weighted signal characteristics. Closed reduction was attempted in all patients and neurologic status was measured on admission and following reduction. MR image was obtainted within three days after early closed reduction. RESULTS: Early closed reduction by Gardner-Wells skeletal traction and serial plain radiography was achieved in 90% of patients and there was no associated neurological deterioration after reduction. The incidence of disc injury at the level of the fracture subluxation on the postreduction MR images was 60%(herniation-30%, disruption-30%), but the presence of disc herniation or disruption did not affect the degree of neurological recovery, as measured by American Spinal Injury Association(ASIA) motor score and the Frankel scale following early closed reduction. The average ASIA motor score prior reduction was 48.4 compared with 62.5 following reduction. CONCLUSION: Although disc herniation and disruption can occur following traumatic cervical fracture-dislocation, the actual incidence of neurological deterioration following early closed reduction is rare. Therefore, immediate closed reduction using traction in patients with any neurological deficit can be safe and effective before MR imaging.