当前位置： SCI文献检索 > JOURNAL OF NEUROSURGERY期刊下所有文献 > Risk of early closed reduction in cervical spine subluxation injuries.

Risk of early closed reduction in cervical spine subluxation injuries.

Abstract：

OBJECT:The authors retrospectively reviewed 121 patients with traumatic cervical spine injuries to determine the risk of neurological deterioration following early closed reduction. METHODS:After excluding minor fractures and injuries without subluxation, the medical records and imaging studies (computerized tomography and magnetic resonance [MR] images) of 82 patients with bilateral and unilateral locked facet dislocations, burst fractures, extension injuries, or miscellaneous cervical fractures with subluxation were reviewed. Disc injury was defined on MR imaging as the presence of herniation or disruption: a herniation was described as deforming the thecal sac or nerve roots, and a disruption was defined as a disc with high T2-weighted signal characteristics in a widened disc space. Fifty-eight percent of patients presented with complete or incomplete spinal cord injuries. Thirteen percent of patients presented with a cervical radiculopathy, 22% were intact, and 9% had only transient neurological deficits in the field. Early, rapid closed reduction, using serial plain radiographs or fluoroscopy and Gardner-Wells craniocervical traction, was achieved in 97.6% of patients. In two patients (2.4%) closed reduction failed and they underwent emergency open surgical reduction. The average time to achieve closed reduction was 2.1+/-0.24 hours (standard error of the mean). The incidence of disc herniation and disruption in the 80 patients who underwent postreduction MR imaging was 22% and 24%, respectively. However, the presence of disc herniation or disruption did not affect the degree of neurological recovery, as measured by American Spinal Injury Association motor score and the Frankel scale following early closed reduction. Only one (1.3%) of 80 patients deteriorated, but that occurred more than 6 hours following closed reduction. CONCLUSIONS:Although disc herniation and disruption can occur following all types of traumatic cervical fracture subluxations, the incidence of neurological deterioration following closed reduction in these patients is rare. The authors recommend early closed reduction in patients presenting with significant motor deficits without prior MR imaging.

journal_name

J Neurosurg

journal_title

Journal of neurosurgery

authors

Grant GA,Mirza SK,Chapman JR,Winn HR,Newell DW,Jones DT,Grady MS

doi

10.3171/spi.1999.90.1.0013

subject

Has Abstract

pub_date

1999-01-01 00:00:00

pages

13-8

issue

1 Suppl

eissn

0022-3085

issn

1933-0693

journal_volume

pub_type

杂志文章

在线工具

Risk of early closed reduction in cervical spine subluxation injuries.