- Discussion:
- treatment of jump locked or perched facets is reduction by halo traction and then placement of a halo jacket;
- closed reduction usually succeeds;
- Diff Dx:
- prior to attempted reduction ensure that the diagnosis is correct;
- the differential diagnosis should include pure cervical distraction injuries which at first glance can resemble a facet dislocation;
- this type of injury should not be managed w/ halo traction since this would be expected to only worsen the injury;
- Pre-Reduction Considerations:
- w/ facet joint subluxation in an alert and cooperative patient consider immediate reduction w/o MRI;
- some surgeons, however, recommend MRI imaging before reduction or operative intervention is attempted;
- facet dislocations, frequently are accompanied by disc herniation into anterior part of the spinal canal;
- marked protrusion of disc material into spinal canal may occur in about 10% of pts who had subluxation or dislocation
of a cervical facet;
- in pts who have such injury, catastrophic compression of spinal cord can result from an uncontrolled facet reduction;
- in this case, consider anterior discectomy and fusion followed by posterior fusion;
- Monitoring of Neuro Status:
- pt must be admitted to intensive care unit or setting w/ one to one nursing care to monitor his neurologic status;
- reduction is done w/ close monitoring of neurological & x-ray status of pt, preferably when pt is awake and alert.
- Traction Force (needed amount is variable);
- skeletal traction, positioning, & postural bumps assist reduction;
- up to one third of body weight may be required;
- safe upper limits have not been established, although published reports include forces up to 60-75 lbs;
- wt is added incrementally, w/ x-rays being made after each addition;
- begin w/:
- 10 lbs is added for occiput;
- additional 5 lbs, for ea vertebra to level of injury;
- but begin w/ < 20 libs;
- re-evaluation:
- after placement of wt, check lateral X-ray & full Neuro Exam;
- if reduction does not occur, wt. is then added in 5 lbs increments, in approximate half hour intervals, being certain to repeat
lateral X-ray and the Neuro Exam after each wt. increase;
- max amount of traction wt that can be applied safely is unknown;
- up to 20 lbs can be applied to C1 & C2;
- up to 50 lbs can be applied in lower cervical region (C3-C7);
- if the reduction does not occur after using 35-40 lbs, ORIF and fusion is indicated;
- some recommend a much greater force be used;
- once reduction has been achieved, traction wt can be reduced to 20 lbs (9.1 kg) or less to maintain alignment;
- Failed Reduction:
- w/ neurological deficit unsuccessful reduction by 3-6 hrs after trauma is an indication of open reduction and stabilization;
- closed reduction attempts are discontinued when:
- reduction is achieved
- when > 1 cm of distraction occurs at site of injury;
- when neurological status of pt deteriorates;
- when maximum amount of weight is applied;
- redislocation:
- prevented w/ moderate cervical extension & traction
Year Book: Closed Reduction of Cervical Spine Dislocations.
Rapid traction for reduction of cervical spine dislocations.