MANIPULATION FOR CERVICAL SPINAL DISLOCATION UNDER GENERAL-ANESTHESIA- SERIAL REVIEW FOR 4 YEARS

Manipulation under anaesthesia is an important method to reduce cervic al spinal dislocations in the acute stage. Causes of failure have not been clearly identified and neurological complications can be the majo r concern. All cervical dislocations have been traditionally treated b y manipulation under anaesthesia in the Christchurch Spinal Injuries U nit as the primary treatment. We reviewed all 31 patients treated from 1991-1995, with detailed documentation of neurological progression an d final outcome. Three patterns were identified: bilateral dislocation , unifacet dislocation and fracture dislocation. Most of the dislocati ons (74%) were successfully reduced by manipulation alone with minimum complications. The remaining 26% patients required open reduction. Th e predominant causes of failure of reduction by manipulation were co-e xisting fractures. The success rate of reduction by manipulation was 9 0% for pure bifacet and unifacet dislocations, but was only 22% for th e fracture dislocations. The study concluded that manipulation under a naesthesia is a safe and effective procedure for pure cervical spinal dislocations. Fractures related to the dislocation should be identifie d early and open reduction be considered.