77 - Initial closed reduction of lower cervical spine fracture and dislocation

Introduction
Lower cervical spine fracture and dislocation is one of the most severe injuries to the spine. It is necessary to restore the normal sequence of cervical spine and to reduce cervical spinal cord compression as soon as possible. The cranial tong traction can quickly reduce the dislocation.
Objective
To investigate the value and safety of initial closed reduction of lower cervical spine fracture and dislocation with cranial tong traction.
Methods
A retrospective analysis was performed on patients with fracture-dislocation of the lower cervical spine (C3-7) combined with facet joint interlocking from January 2015 to January 2020, 50 patients with complete data and a follow-up time of more than 12 months were involved. 26 cases (traction group) were treated with cranial tong traction in stage I combined with anterior cervical decompression and fusion in stage II. 24 patients (pry-up group) were treated with anterior open pry-up reduction, decompression and fusion in stage II. The operative time and intraoperative hemorrhage among two groups were compared. The cervical X-ray before and after surgery was observed, the intervertebral space height and Cobb angle were compared. The neurological recovery of two groups was evaluated by classification of American spinal injury association、motor function and sensory function score by American spinal injury association. The incidence of postoperative complications was compared between the two groups.
Results
The 50 patients were followed up for 12 to 15 months, with an average of 13.3 months. The operation time of traction group was shorter than that in pry-up group (P < 0.05), and the amount of intraoperative bleeding was less than that in pry-up group (P < 0.05). The height of cervical intervertebral space and Cobb angle in the two groups were significantly improved compared with pre-operation (P < 0.05); while there was no significant difference in cervical intervertebral space height and Cobb angle between the two groups post-operation(P>0.05). At the last follow-up periods, the ASIA motor and sensory function scores of the two groups were higher than pre-operation (P < 0.05); and compared between the two groups, the ASIA motor and sensory function scores of the traction group were better than the pry-up group (P < 0.05). The classification of ASIA in two groups at last follow-up was significantly improved compared with pre-operation (P < 0.05); there was no significant difference (P=0.108) between each other. In the pry-up group, there were 8 cases of throat pain, 1 case of hoarseness, 1 case of incision infection, The incidence of postoperative complications was 41.67%; in traction group, there were 2 cases of throat pain, no hoarseness and incision infection occurred, the incidence of postoperative complications was 7.69%, and the incidence of complications in the traction group was lower than that in the pry-up group (P < 0.05).
Conclusion
Cranial tong traction reduction under emergency care has a good clinical effect in the treatment of lower cervical spine fractures-dislocations with facet joint interlocking, which has a better improvement of neurological function, and reduce surgical trauma, risks as well as complications.