THE PLACE OF CLOSED MANIPULATION IN THE MANAGEMENT OF FLEXION-ROTATION DISLOCATIONS OF THE CERVICAL SPINE

Abstract

1. The pathology and pathogenesis of dislocations and fracture-dislocations of the cervical spine has been reviewed. 2. A method of treatment using skeletal traction and manipulation under relaxant general anaesthesia is described. Results of treatment are given for all patients admitted to the Centre with flexion-rotation dislocations of the cervical spine complicated by neurological lesions, between November 1961 and December 1968. 3. After reviewing the literature and considering the results obtained in seventy-six cases, we advocate a policy of conservative management with gentle manipulation of the cervical spine in selected cases, reduction being maintained thereafter by skeletal traction. We reserve operation for the few cases that demonstrate late instability or for those rarer cases in which manipulation fails and the patient has either an incomplete neurological lesion or a double skeletal injury. 4. The low incidence of late instability after adequate conservative treatment is stressed, and the danger of overdistraction of the cervical spine by heavy traction in patients with severe ligamentous damage is emphasised.