REDUCTION AND POSITIONING OF CERVICAL-SPINE INJURIES

Prerequisites for successful reduction of cervical spine injuries are an exact analysis and classification of every lesion. In locked disloc ations disc protrusion should be excluded Drier to reduction by MRI or CT-scan. For manual reduction and closed manipulation by the trauma s urgeon we use a halo-ring which is applied in local anaesthesia and fl uoroscopic control. The anatomic position is maintained by a halo-fixa tor until surgery. Skeletal traction is used mainly for locked disloca tions and late malalignements. Traction is provided by a halo-ring and weights up to 20 kg. Repeated clinical and neurological examinations are necessary to rule out overdistraction of the spine or neurologic d eterioration. The weight may be reduced after reduction to 2 kg. For i ntraoperative positioning and reduction of cervical spine injuries we designed a special device which is connected to the halo ring and allo ws to fix the head and spine in any desired position. It may be used i n prone or supine position of the patient. Operative reductions are ra rely necessary on the cervical spine. Typical indication are fractures of posterior elements of the spine preventing closed reduction. Reduc tion manoeuvers depend on the kind of injury and are mainly composed o f traction and a reversal of the trauma mechanism. The most severe com plication is a neurologic deterioration. Reports in literature about 1 3 patients having sustained such a fate are showing the following: In most cases disc material dislocated in the spinal canal during reducti on could be made reponsible for the catastrophic course. Especially at risk are patients with open reduction from a posterior approach.