A survey of the use of traction for the reduction of cervical dislocations
Background: Literature supports early decompression of low energy cervical spine dislocations. Closed reduction can safely and rapidly achieve this; however, its use and acceptance among specialists is poorly described. This study aimed to assess the training, experience and decision-making of trainees and surgeons who manage cervical spine dislocations with the goal of reinforcing educational programmes as necessary. The objective was to assess the need to implement further training for trainees and specialists involved in the management of cervical spine dislocations.
Methods: Orthopaedic and neurosurgery registrars and specialists in South Africa were emailed a questionnaire consisting of 13 questions related to their training, experience and management of cervical dislocations.
Results: Seventy-nine per cent (n=62) of surgeons were taught closed reduction during specialist training. Ninety-two per cent (n=12) of neurosurgeons covered spine trauma compared to 66% (n=42) of orthopaedic surgeons. Of surgeons covering trauma, 21% (n=16) would refer the patient on, accepting a 2-hour delay in treatment. Forty-two per cent (n=5) of neurosurgeons vs <2% (n=1) of orthopaedic surgeons preferred MRI before closed reduction. Fifty-six per cent (n=40) of surgeons thought that the risk of worsening neurology during traction was up to 25%. Sixty-nine per cent (n=54) of surgeons felt emergency room (ER) doctors could safely perform closed cervical reduction with training. Fifty-one per cent of surgeons do not think cervical reduction is routinely possible in under 4 hours.
Conclusion: The public and specialists have misconceptions around cervical traction which may affect best clinical practice and optimum management. Cervical traction does not require prior MRI and carries a very low risk of worsening a patient’s condition. Closed cervical traction reduction is the most rapid, safe mechanism to reduce cervical dislocations and requires specific education of undergraduates, emergency doctors, and specialists to increase awareness of the reduction process.
Level of evidence: Level 4